Omar Mohammed Javery MD, Presenter: Nothing to Disclose

Paul B. Shyn MD, Abstract Co-Author: Nothing to Disclose

Koenraad J. Mortele MD, Abstract Co-Author: Nothing to Disclose

To determine the impact of FDG PET findings as compared to diagnostic CT or MR in the clinical management of patients with pancreatic cancer.

This retrospective, IRB-approved study included consecutive patients with pathology-proven pancreatic adenocarcinoma between January 2000 and September 2009 with at least one FDG PET or PET/CT scan performed for a pancreatic cancer indication. Forty-nine patients (24M, 25F, ages 44-84, mean 66) underwent 75 PET or unenhanced PET/CT scans for initial staging (n=26), restaging after completion of first-line therapy (n=35), therapy monitoring during second or third-line chemotherapy (n=12), or surgical/biopsy planning (n=2). Contemporaneous abdominal CT or MR scans performed with IV contrast and within 4 weeks of PET or PET/CT were available for 65 PET or PET/CT scans in 48 patients. For 6 patients, 10 PET/CT scans did not have contemporaneous CT or MR, therefore PET findings were correlated with the CT component of the PET/CT. Imaging findings were correlated with detailed review of medical records.

PET findings with the potential to impact clinical management were found in 67 of 75 PET or PET/CT scans, however, only ten scans demonstrated PET findings not well-characterized on CT or MR. Five of 75 (6.7%) scans altered management correctly with true positive PET findings: initial staging (1/26), restaging (1/35), therapy monitoring (3/12), and biopsy/surgery planning (0/2). Five of 75 (6.7%) scans altered management incorrectly (false positive/negative PET findings): staging (1/26), restaging (2/35), therapy monitoring (1/12), and biopsy planning (1/2). PET did not favorably impact clinical management over CT or MR alone in 93.3% (70/75) of scans.

FDG PET findings, not evident on CT or MR alone, were equally likely to favorably or adversely impact clinical management in patients with pancreatic cancer, but had greater utility when used specifically for monitoring response during second or third-line chemotherapy.

This study addresses the clinical impact on management, by indication, of FDG PET or PET/CT findings not well-characterized on abdominal CT or MR alone, in patients with pancreatic cancer.

Javery, O, Shyn, P, Mortele, K, FDG PET or PET/CT in Patients with Pancreatic Cancer: When Does It Add to Diagnostic CT or MRI?.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9001741.html