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. 2023 Nov 14;15(22):5403.
doi: 10.3390/cancers15225403.

Detection of Liver Lesions in Colorectal Cancer Patients Using 18F-FDG PET/CT Dual-Time-Point Scan Imaging

Luciane G Boanova  1   2 , Stephan Altmayer  1 , Guilherme Watte  3 , Ana Amelia Raupp  2 , Martina Zaguini Francisco  3 , Guilherme Strieder De Oliveira  4 , Bruno Hochhegger  1 , Rubens G F Andrade  1
Affiliations

Detection of Liver Lesions in Colorectal Cancer Patients Using 18F-FDG PET/CT Dual-Time-Point Scan Imaging

Luciane G Boanova et al. Cancers (Basel). .

Abstract

Objective: The aim of this study was to evaluate the diagnostic performance of dual-time-point fluorine-18-fluorodeoxyglucose positron emission computed tomography/computed tomography (18F-FDG PET/CT) compared to conventional early imaging for detecting colorectal liver metastases (CRLM) in colorectal cancer (CRC) patients.

Methods: One hundred twenty-four consecutive CRC patients underwent dual-time-point imaging scans on a retrospective basis. Histopathological confirmation and/or clinical follow-up were accepted as the gold standard. Standard uptake values (SUV), signal-to-noise ratio (SNR), retention index (RI), tumor-to-normal liver ratio (TNR), and lesion sizes were measured for early and delayed PET scans. The diagnostic performance of early and delayed images was calculated on a per-patient basis and compared using McNemar's test.

Results: Among the 124 patients, 57 (46%) had CRLM, 6 (4.8%) had benign lesions, and 61 (49.2%) had no concerning lesions detected. Smaller CRLM lesions (<5 cm3) showed significantly higher uptake in the delayed scans relative to early imaging (p < 0.001). The SUV and TNR increased significantly in delayed imaging of all metastatic lesions (p < 0.001). The retention index of all CRLM was high (40.8%), especially for small lesions (54.8%). A total of 177 lesions in delayed images and 124 in standard early images were identified. In a per-patient analysis, delayed imaging had significantly higher sensitivity (100% vs. 87.7%) and specificity (91.0% vs. 94.0%) compared to early imaging (p-value = 0.04).

Conclusions: The detection of liver lesions using dual-time-point PET/CT scan improves the sensitivity and specificity for the detection of colorectal liver metastasis.

Keywords: 18F-FDG PET/CT; colorectal cancer; colorectal liver metastases; delayed scan; early scan.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
68-year-old patient with colorectal cancer and no liver lesion detected on contrast-enhanced computed tomography. (a) Coronal MIP, axial PET, axial CT, and fused CT during the early phase did not demonstrate any hypermetabolic focal liver lesion; (b) Coronal MIP, axial PET, axial CT, and fused images during the delayed phase demonstrate a focal hypermetabolic lesion in hepatic segment 5 corresponding to a liver metastasis.
Figure 2
Figure 2
61-year-old female with colorectal cancer and a single hypermetabolic liver lesion in the left lobe on both (a) delayed (SUVmax 14.3) and (b) early phases (SUVmax 13.4). Histopathological analysis confirmed the diagnosis of hepatic adenoma.
Figure 3
Figure 3
Tumor-to-normal liver ratio and retention index values obtained. (a) The TNR in delayed PET scans was significantly higher than in the standard early PET images (p < 0.0001), especially in small lesions (p < 0.0001); (b) The RI of small lesions was significantly higher than large lesions.
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