title: Split-dose technique for FDG PET/CT-guided percutaneous ablation: a method to facilitate lesion targeting and to provide immediate assessment of treatment effectiveness.
abstract: OBJECTIVE
  To describe a split-dose technique for fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT)-guided ablation that permits both target localization and evaluation of treatment effectiveness.
  
  
  METHODS
  Institutional review board approved the study with a waiver of consent. From July to December 2011, 23 patients (13 women, 10 men; mean age, 59 years; range, 35-87 years) with 29 FDG-avid tumors (median size, 1.4 cm; range, 0.6-4.4 cm) were targeted for ablation. The location of the lesion was the liver (n = 23), lung (n = 4), adrenal gland (n = 1), and thigh (n = 1). Radiofrequency ablation was performed in 17 lesions; microwave ablation, in six; irreversible electroporation, in five; and cryoablation, in one. The pathologic condition of the tumor was metastatic colorectal adenocarcinoma in 18 lesions, primary hepatocellular carcinoma in one lesion, and a variety of metastatic tumors in the remaining 10 lesions. A total of 4 mCi (148 MBq) of FDG was administered before the procedure for localization and imaging guidance. At completion of the ablation, an additional 8 mCi (296 MBq) of FDG was administered to assess ablation adequacy. Results of subsequent imaging follow-up were used to determine if postablation imaging after the second dose of FDG reliably helped predict complete tumor ablation. Descriptive statistics were used to summarize the results.
  
  
  RESULTS
  Twenty-eight of 29 (97%) ablated lesions showed no residual FDG activity after the second intraprocedural FDG dose. One patient with residual activity underwent immediate biopsy that revealed residual viable tumor and was immediately re-treated. Follow-up imaging at a median of 155 days (range, 92-257 days) after ablation showed local recurrences in two (7%) lesions that were originally negative at postablation PET.
  
  
  CONCLUSIONS
  Split-dose FDG PET/CT may be a useful tool to provide both guidance and endpoint evaluation, allowing an opportunity for repeat intervention if necessary. Further work is necessary to validate these concepts.
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Suite H118, New York, NY 10065, USA.
authors.forename: E Ronan
authors.initials: ER
authors.lastname: Ryan
authors.forename: Constantinos T
authors.initials: CT
authors.lastname: Sofocleous
authors.forename: Heiko
authors.initials: H
authors.lastname: Schöder
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Carrasquillo
authors.forename: Sadek
authors.initials: S
authors.lastname: Nehmeh
authors.forename: Steven M
authors.initials: SM
authors.lastname: Larson
authors.forename: Raymond
authors.initials: R
authors.lastname: Thornton
authors.forename: Robert H
authors.initials: RH
authors.lastname: Siegelbaum
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Erinjeri
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Solomon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
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