title: Added value of FDG-PET imaging in the diagnostic workup for yttrium-90 radioembolisation in patients with colorectal cancer liver metastases.
abstract: OBJECTIVE
  Yttrium-90 radioembolisation (Y90-RE) is recommended for unresectable, chemorefractory liver-dominant disease; however, the incidence of extrahepatic disease (EHD) is high. FDG-PET may have additional value to CT in demonstrating EHD. Our aim was to evaluate the added diagnostic value of FDG-PET to abdominal CT and study the influence of FDG-PET findings on treatment decisions.
  
  
  METHODS
  All consecutive patients with colorectal cancer liver metastases (CRCLM) referred for Y90-RE were included. Patients who underwent both CT and FDG-PET in the diagnostic workup were selected. Imaging reports were scrutinised for documented sites of EHD, and changes of management due to FDG-PET findings were determined.
  
  
  RESULTS
  A total of 42 patients were included. Findings on CT and FDG-PET matched in 20 patients (no EHD, n = 15; identical EHD, n = 5). In 4 patients, lesions detected on CT were not FDG-avid, and in 18 patients, FDG-PET showed more lesions than CT (P < 0.05). In 7/42 patients (17 %) a change of management was made based on the additional FDG-PET findings, i.e. exclusion from Y90-RE treatment (n = 6) and change in treatment plan (whole liver rather than segmental treatment, n = 1).
  
  
  CONCLUSIONS
  In patients with CRCLM referred for Y90-RE, FDG-PET showed significantly more EHD and led to a considerable change of management.
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, 3584 CX, Utrecht, The Netherlands. c.rosenbaum@umcutrecht.nl
authors.forename: Charlotte E N M
authors.initials: CE
authors.lastname: Rosenbaum
authors.forename: M A A J
authors.initials: MA
authors.lastname: van den Bosch
authors.forename: W B
authors.initials: WB
authors.lastname: Veldhuis
authors.forename: J E
authors.initials: JE
authors.lastname: Huijbregts
authors.forename: M
authors.initials: M
authors.lastname: Koopman
authors.forename: M G E H
authors.initials: MG
authors.lastname: Lam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000556:secondary*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes; D019788:Fluorodeoxyglucose F18