title: Diagnostic accuracy of F-18 FDG PET/CECT vs. CECT for detecting recurrence of periampullary carcinoma and its prognostic significance.
abstract: OBJECTIVE
  To evaluate the additive value of whole-body F-18 fluoro-deoxyglucose positron emission tomography (FDG PET) as an adjunct to contrast-enhanced computed tomography (CECT) for detecting recurrence following Whipple's resection for periampullary carcinoma and to analyze the prognostic significance of FDG PET-/CECT-based detection of recurrence.
  
  
  METHODS
  Fifty patients (34 males, 16 females; mean age: 55 ± 11 years) who underwent PET/CECT following resection of periampullary carcinoma were included. The study was duly approved by the institutional ethical committee for retrospective analysis of the data. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of FDG PET/CECT and CECT alone for detection of recurrence were calculated, and the accuracy was compared with ROC analysis. The prognostic factors for survival following recurrence were analyzed by univariate and multivariate methods.
  
  
  RESULTS
  PET/CECT indicated recurrence of disease in 26 (52%) patients. The overall mean survival time was 46 months with an overall survival rate of 42%. The sensitivity, specificity, PPV, NPV and accuracy of PET/CECT and CECT for detection of recurrence were 96.1%, 91.6%, 92.6%, 95.6%, 94% and 76.9%, 75%, 76.9%, 75%, 76%, respectively (p = 0.037). Also change in management could have been achieved in 18% of patients based on the PET/CECT results. In univariate analyses, SUVmax >7.3 was the only predictor of poor survival (p < 0.05).
  
  
  CONCLUSIONS
  PET/CECT could be used as a one-stop imaging tool for staging and prognostication of recurrent periampullary carcinoma that could result in better patient management.
authors: Department of Nuclear medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India, santhosh610@yahoo.com.
authors: Sampath
authors: S
authors: Santhosh
authors: Bhagwant Rai
authors: BR
authors: Mittal
authors: Mandeep
authors: M
authors: Kang
authors: Rakesh
authors: R
authors: Kapoor
authors: Rajesh
authors: R
authors: Gupta
authors: Surinder
authors: S
authors: Rana
authors: Anish
authors: A
authors: Bhattacharya
authors: Deepak
authors: D
authors: Bhasin
mesh_terms: D001650:Bile Duct Neoplasms / Q000175:diagnosis*; D001652:Bile Ducts / Q000000981:diagnostic imaging; D002277:Carcinoma; D002758:Cholangiography; D003287:Contrast Media; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D049268:Positron-Emission Tomography; D011379:Prognosis; D012372:ROC Curve; D011856:Radiographic Image Enhancement; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18