title: Clinical impact of FDG PET-CT on management decisions for patients with primary biliary tumours.
abstract: OBJECTIVE
  To assess the impact on clinical management of introducing (18)F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)-computed tomography (CT) in to the work-up of patients with primary and recurrent biliary malignancy.
  
  
  METHODS
  Consecutive patients with primary biliary tumours undergoing FDG PET-CT at a single large tertiary referral centre between November 2007 and September 2010 were retrospectively analysed. Findings on FDG PET-CT compared with CT/magnetic resonance imaging (MRI) and impact on subsequent patient management were evaluated. Impact was divided into: (1) major-detection of occult disease or characterisation of indeterminate lesion(s) on CT/MRI; (2) minor-confirmation of suspected metastases seen on CT/MRI; (3) no impact.
  
  
  RESULTS
  One hundred and eleven patients underwent 118 FDG PET-CT scans, including 30 with suspected gallbladder carcinoma and 81 with cholangiocarcinoma. Eighty-nine scans were performed for initial staging, five for restaging following neoadjuvant chemotherapy and 24 for suspected disease recurrence. In 33 cases (28 %), FDG PET-CT had a major impact on subsequent patient management (39 % gallbladder carcinoma, 26 % intrahepatic cholangiocarcinoma and 21 % extrahepatic cholangiocarcinoma). FDG PET-CT had a minor impact in 20 cases (17 %) and no impact in 65 cases (55 %).
  
  
  CONCLUSIONS
  By detecting occult metastatic disease and characterising indeterminate lesions, FDG PET-CT can have a major influence on clinical decision-making in primary and recurrent biliary malignancy.
authors.affiliation: Department of Radiology, Level 0, Bexley Wing, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK, raneemalbazaz@hotmail.com.
authors.forename: Raneem
authors.initials: R
authors.lastname: Albazaz
authors.forename: Chirag N
authors.initials: CN
authors.lastname: Patel
authors.forename: Fahmid U
authors.initials: FU
authors.lastname: Chowdhury
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Scarsbrook