J Korean Soc Radiol.  2010 Feb;62(2):149-157. 10.3348/jksr.2010.62.2.149.

Detection of Intra-Abdominal Tumor Recurrence in Patients with Cholangiocarcinoma: Comparison of Contrast-Enhanced MDCT and 18F FDG-PET/CT

• Kang YJ
• Heo SH
• Kim JW
• Shin SS
• Chang NK
• Choi S
• Cho CK
• Bom HS
• Jeong YY
• Kang HK

• KMID: 2208955
• DOI: http://doi.org/10.3348/jksr.2010.62.2.149

Abstract

PURPOSE: This study was designed to compare the diagnostic accuracy between the use of contrast-enhanced CT (CECT) and PET/CT for the detection of tumor recurrence in post-operative patients with cholangiocarcinoma during follow-up.
MATERIALS AND METHODS
Twenty-five patients who had undergone abdominal CT and PET/CT examinations had clinical or imaging feature suspicious of recurrence. Ultimately, 16 patients (mean age, 65.1 years) were included in the study. The presence of recurrence was confirmed based on follow-up imaging (n = 10) or a biopsy (n = 6). Sensitivity, specificity and accuracy between the use of CECT and PET/CT were compared.
RESULTS
Sixteen patients were found to have tumor recurrence. On a per patient basis, the sensitivity, specificity and accuracy for the use of CECT for tumor recurrence were 69%, 50% and 65%, respectively. The sensitivity, specificity and accuracy for the use of PET/CT for tumor recurrence were 100%, 75% and 95%, respectively. On a per lesion basis, the sensitivity, specificity and accuracy for the use of CECT for tumor recurrence were 73%, 50% and 70%, respectively. The sensitivity, specificity and accuracy for the use of PET/CT for tumor recurrence were 100%, 75% and 97%, respectively. PET/CT had significantly higher sensitivity and accuracy as compared to CT for the detection on a per lesion basis for recurred cholangiocarcinoma (p < 0.01).
CONCLUSION
PET/CT was more sensitive and accurate for the detection of recurrence of cholangiocarcinoma as compared to CECT. A PET/CT examination should be included in post-operative follow-up studies for the evaluation of recurred cholangiocarcinoma.

MeSH Terms

Bile Ducts
Biopsy
Cholangiocarcinoma
Follow-Up Studies
Humans
Positron-Emission Tomography
Recurrence
Sensitivity and Specificity

Figure

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  Fig. 1 Local recurrence in a 57-year-old man who had a history of right hepatectomy, bile duct resection and hepaticojejunostomy for Klatskin tumor. A. Contrast-enhanced CT (CECT) reveals recurred mass (arrows) in the right side of peripancreatic area. Axial (B) and coronal (C) PET/CT show that focal hypermetabolic lesion (arrows) corresponds to a recurred mass (arrows) on CECT.

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  Fig. 2 Local recurrence in a 78-year-old man who had a history of right hepatectomy and Roux-en-Y hepaticojejunostomy for peripheral cholangiocarcinoma. A. Contrast-enhanced CT (CECT) shows no definite delineation of recurred mass at anastomotic site (arrows) in 1 years later after operation. B. Corresponding axial PET/CT demonstrate hypermetabolic lesion with SUV 9.1 (arrows), suggestive of recurred mass. C. Follow up CECT after 8 months, CECT shows irregular marginated heterogenously enhancing mass (arrows) at anastomotic site.

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  Fig. 3 Hepatic metastasis in a 71-year-old man who had a history of Whipple's operation for distal CBD cancer. A. Contrast-enhanced CT shows a about 3.5 cm heterogenous enhancing lesion (arrows) in hepatic dome. B. Corresponding axial PET/CT demonstrates focal hypermetabolic lesion (arrows) on hepatic dome.

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  Fig. 4 Lymph node metastasis in a 53-year-old man who had a history of pylorus-preserving pancreatoduodenectomy (PPPD) for distal CBD cancer. A. Contrast-enhanced CT (CECT) shows a about 0.7 cm lymph node (arrow) around aortic bifurcation level, suggestive of benign lymph node. B. Corresponding axial PET/CT shows hypermetabolic metastatic lymph node (arrow) around aortic bifurcation level. C. Follow up CECT after 6 month reveals increased size of lymph node (arrow), suggestive of metastatic lymph node.

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  Fig. 5 Peritoneal seeding in a 54-year-old man who had a history of Whipple's operation for distal CBD cancer. A. Contrast-enhanced CT (CECT) shows irregular peritoneal thickening and scalloping of hepatic surface. B. Corresponding axial PET/CT shows hypermetabolic lesion in perihepatic space.

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