title: Accuracy of 18F-FDG PET/CT, Multidetector CT, and MR Imaging in the Diagnosis of Pancreatic Cysts: A Prospective Single-Center Study.
abstract: Accurate diagnosis of the nature of pancreatic cysts is challenging but more important than ever, in part because of the increasing number of incidental cystic findings in the pancreas. Preliminary data suggest that (18)F-FDG PET/CT may have a significant influence on clinical decision making, although its role is still evolving. Our aim was to prospectively compare the accuracy of combined (18)F-FDG PET and contrast-enhanced CT ((18)F-FDG PET/CT), multidetector CT (MDCT), and MR imaging in differentiating malignant from benign pancreatic cysts.
  
  
  METHODS
  Thirty-one consecutive patients with pancreatic cysts were enrolled in the study. They underwent a protocol including (18)F-FDG PET/CT, MDCT, and MR imaging combined with MR cholangiopancreatography, all of which were evaluated in a masked manner. The findings were confirmed macroscopically at surgery or histopathologic analysis (n = 22) or at follow-up (n = 9).
  
  
  RESULTS
  Of the 31 patients, 6 had malignant and 25 had benign lesions. The diagnostic accuracy was 94% for (18)F-FDG PET/CT, compared with 77% and 87% for MDCT (P < 0.05) and MR imaging, respectively. (18)F-FDG PET/CT had a negative predictive value of 100% and a positive predictive value of 75% for pancreatic cysts. The maximum standardized uptake value was significantly higher in malignant (7.4 ± 2.6) than in benign lesions (2.4 ± 0.8) (P < 0.05). When the maximum standardized uptake value was set at 3.6, the sensitivity and specificity were 100% and 88%, respectively. Furthermore, when compared with MDCT and MR imaging, respectively, (18)F-FDG PET/CT altered the clinical management of 5 and 3 patients, respectively.
  
  
  CONCLUSIONS
  (18)F-FDG PET/CT is an accurate imaging modality for differentiating between benign and malignant pancreatic cysts. We recommend the use of (18)F-FDG PET/CT in the evaluation of diagnostically challenging pancreatic cysts.
authors.affiliation: Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland Turku PET Centre, Turku University Hospital, Turku, Finland saila.kauhanen@tyks.fi.
authors.forename: Saila
authors.initials: S
authors.lastname: Kauhanen
authors.affiliation: Department of Radiology, Tampere University Hospital, Tampere, Finland.
authors.forename: Irina
authors.initials: I
authors.lastname: Rinta-Kiikka
authors.affiliation: Turku PET Centre, Turku University Hospital, Turku, Finland Department of Clinical Physiology and Nuclear Medicine, Turku, Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Kemppainen
authors.affiliation: Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Grönroos
authors.affiliation: Turku PET Centre, Turku University Hospital, Turku, Finland.
authors.forename: Sami
authors.initials: S
authors.lastname: Kajander
authors.affiliation: Turku PET Centre, Turku University Hospital, Turku, Finland Department of Clinical Physiology and Nuclear Medicine, Turku, Finland.
authors.forename: Marko
authors.initials: M
authors.lastname: Seppänen
authors.affiliation: Department of Pathology, Turku University Hospital, Turku, Finland; and.
authors.forename: Kalle
authors.initials: K
authors.lastname: Alanen
authors.affiliation: Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.
authors.forename: Risto
authors.initials: R
authors.lastname: Gullichsen
authors.affiliation: Turku PET Centre, Turku University Hospital, Turku, Finland Department of Medicine, University of Turku, Turku, Finland.
authors.forename: Pirjo
authors.initials: P
authors.lastname: Nuutila
authors.affiliation: Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Ovaska
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D003287:Contrast Media / Q000737:chemistry; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D010181:Pancreatic Cyst / Q000175:diagnosis / Q000000981:diagnostic imaging*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: PET; diagnosis; pancreatic cyst