Bernhard Klumpp MD, Presenter: Nothing to Disclose

Nina Schwenzer MD, Abstract Co-Author: Nothing to Disclose

Ingmar Koenigsrainer, Abstract Co-Author: Nothing to Disclose

Alfred Koenigsrainer MD, Abstract Co-Author: Nothing to Disclose

Claus Detlef Claussen MD, Abstract Co-Author: Nothing to Disclose

Christina Pfannenberg MD, Abstract Co-Author: Nothing to Disclose

In patients with peritoneal carcinomatosis (PC) cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is an evolving therapeutic approach with curative intention. To differentiate between posttherapeutic findings and relapse of PC is challenging. Due to promising results in the preoperative assessment of PC we evaluated the diagnostic value of 18F FDG-PET/CT in the follow up period to detect relapse of PC after cytoreductive surgery and HIPEC.

37 patients with relapse or recurring relapse of PC after HIPEC were examined on a whole body PET/CT system (44 examinations). To provide intestinal distention and reduce motion artifacts, 1000 ml mannitol solution were administered orally and 40 mg of butylscopolaminiumbromid injected i.v.. 350 MBq 18F FDG were injected 1h prior to PET/CT. Image acquisition covered the whole body from base of skull to upper limbs. Images were assessed by two experienced radiologist regarding presence and extent of PC using the peritoneal carcinomatosis index proposed by Sugarbaker et al. Surgical findings were correlated with imaging results. Sensitivity, specificity, PPV, NPV and diagnostic accuracy (DA) were calculated.

Relapse was suspected in 40 of 44 18F-FDG PET/CT examinations at 343±267 days after HIPEC. PC was suspected in 237 of 572 peritoneal segments. Relapse of PC was completely missed by 18F-FDG PET/CT in 4 patients and significantly underestimated in 8 patients. Resulting sensitivity for the accurate detection of relapse of PC after HIPEC was 70%, PPV 97% and DA 70%.

Compared to good preoperative results in the assessment of the extent of PC, the diagnostic yield of 18F-FDG PET/CT after cytoreductive surgery and HIPEC is significantly reduced regarding the presence of PC at all as well as the extent of PC due to the restricted ability to differentiate between posttherapeutic findings and manifestations of PC.

The diagnostic value of 18F-FDG PET/CT to evaluate the presence and extent of recurring PC after cytoreductive surgery and HIPEC is restricted to preoperative results.

Klumpp, B, Schwenzer, N, Koenigsrainer, I, Koenigsrainer, A, Claussen, C, Pfannenberg, C, Assessment of Relapse in Patients with Peritoneal Carcinomatosis after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Using 18F FDG-PET/CT.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13044244.html