Detection of relevant colonic neoplasms with PET/CT: promising accuracy with minimal CT dose and a standardised PET cut-off |
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Authors: | Wolfgang Luboldt Teresa Volker Bärbel Wiedemann Klaus Zöphel Ursula Wehrmann Arne Koch Todd Toussaint Nasreddin Abolmaali Markus Middendorp Daniela Aust Jörg Kotzerke Frank Grünwald Thomas J. Vogl Hans-Joachim Luboldt |
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Affiliation: | 1. Multiorgan Screening Foundation, Frankfurt, Germany 2. Department of Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany 4. Clinic and Policlinic of Nuclear Medicine, University Hospital Dresden, Dresden, Germany 3. Institute of Medical Informatics and Biometrics, University Hospital Dresden, Dresden, Germany 5. Clinic and Policlinic of Surgery, University Hospital Dresden, Dresden, Germany 6. Oncoray, University Hospital Dresden, Dresden, Germany 7. Department of Nuclear Medicine, University Hospital Frankfurt, Frankfurt, Germany 8. Department of Pathology, University Hospital Dresden, Dresden, Germany
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Abstract: | Objective: To determine the performance of FDG-PET/CT in the detection of relevant colorectal neoplasms (adenomas ≥10 mm, with high-grade dysplasia, cancer) in relation to CT dose and contrast administration and to find a PET cut-off. Methods: 84 patients, who underwent PET/CT and colonoscopy (n?=?79)/sigmoidoscopy (n?=?5) for ${left( {{hbox{79}} times {hbox{6}} + {hbox{5}} times {hbox{2}}} right)} = {hbox{484}}$ colonic segments, were included in a retrospective study. The accuracy of low-dose PET/CT in detecting mass-positive segments was evaluated by ROC analysis by two blinded independent reviewers relative to contrast-enhanced PET/CT. On a per-lesion basis characteristic PET values were tested as cut-offs. Results: Low-dose PET/CT and contrast-enhanced PET/CT provide similar accuracies (area under the curve for the average ROC ratings 0.925 vs. 0.929, respectively). PET demonstrated all carcinomas (n?=?23) and 83% (30/36) of relevant adenomas. In all carcinomas and adenomas with high-grade dysplasia (n?=?10) the SUVmax was ≥5. This cut-off resulted in a better per-segment sensitivity and negative predictive value (NPV) than the average PET/CT reviews (sensitivity: 89% vs. 82%; NPV: 99% vs. 98%). All other tested cut-offs were inferior to the SUVmax. Conclusion: FDG-PET/CT provides promising accuracy for colorectal mass detection. Low dose and lack of iodine contrast in the CT component do not impact the accuracy. The PET cut-off SUVmax?≥?5 improves the accuracy. |
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