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Diagnostic impact of 18F-FDG PET–CT evaluating solid pancreatic lesions versus endosonography, endoscopic retrograde cholangio-pancreatography with intraductal ultrasonography and abdominal ultrasound

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

This prospective single-centre phase II trial assessed the diagnostic impact of 18F-FDG PET–CT in the evaluation of solid pancreatic lesions (∅ ≥10 mm) compared to endosonography (EUS), endoscopic retrograde cholangio-pancreatography (ERCP) with intraductal ultrasound (IDUS), abdominal ultrasound (US) and histopathological reference.

Methods

Forty-six patients (32 men/14 women, ∅ 61.7 years) with suspected pancreatic neoplasms underwent PET–CT with contrast-enhanced biphasic multi-detector CT of the upper abdomen followed by a diagnostic work-up with EUS, ERCP with IDUS and US within 3 weeks. PET–CT data sets were analysed by two expert readers in a consensus reading. Histology from surgery, biopsy/fine-needle aspiration and/or clinical follow-up ≥12 months served as standard of reference.

Results

Twenty-seven pancreatic malignancies were histopathologically proven; 19 patients had benign diseases: 36/46 lesions (78%) were detected in the head of the pancreas, 7/46 and 3/46 in the body and tail region, respectively. Sensitivity and specificity of PET–CT were 89% and 74%, respectively; positive predictive value (PPV) and negative predictive value (NPV) were 83% and 82%, respectively. Sensitivity (81–89%), specificity (74–88%), PPV (83–90%) and NPV (77–82%) achieved by EUS, ERCP and US were not significantly different. PET analysis revealed significantly higher maximum mean standardised uptake values (SUVmax 6.5 ± 4.6) in patients with pancreatic malignancy (benign lesions: SUVmax 4.2 ± 1.5; p < 0.05). PET–CT revealed cervical lymphonodal metastasis from occult bronchogenic carcinoma and a tubular colon adenoma with intermediate dysplasia on polypectomy, respectively.

Conclusions

18F-FDG PET–CT achieves a comparably high diagnostic impact evaluating small solid pancreatic lesions versus conventional reference imaging modalities. Additional clinical diagnoses are derived from concomitant whole-body PET–CT imaging.

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Acknowledgements

The authors are indebted to Ms. A. Brunegraf, Ms. C. Schreiber, Ms. I. Markoetter, Ms. F. Schürmann, Ms. S. Huesmann and Ms. B. von Lengerich for skilled technical assistance.

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Authors and Affiliations

  1. Department of Medicine B, Muenster University Hospital, Albert-Schweitzer-Straße 33, 48149, Muenster, Germany

    Verena Schick, Torsten Beyna, Jürgen Schnekenburger, Wolfram Domschke & Thorsten Pohle

  2. Department of Nuclear Medicine, Muenster University Hospital, Albert-Schweitzer-Straße 33, 48149, Muenster, Germany

    Christiane Franzius, Matthias Weckesser & Otmar Schober

  3. Department of Clinical Radiology, Muenster University Hospital, Albert-Schweitzer-Straße 33, 48149, Muenster, Germany

    May Lin Oei, Walter Heindel & Kai Uwe Juergens

  4. Department of Medicine I, Herford Klinikum—Academic Teaching Hospital, Herford, Germany

    Thorsten Pohle

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  1. Verena Schick
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Verena Schick and Christiane Franzius contributed equally to this work.

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Schick, V., Franzius, C., Beyna, T. et al. Diagnostic impact of 18F-FDG PET–CT evaluating solid pancreatic lesions versus endosonography, endoscopic retrograde cholangio-pancreatography with intraductal ultrasonography and abdominal ultrasound. Eur J Nucl Med Mol Imaging 35, 1775–1785 (2008). https://doi.org/10.1007/s00259-008-0818-x

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