Am Surg 1999 Dec;65(12):1183-5
The use of FDG-positron emission tomography for the evaluation of colorectal
metastases of the liver.
Boykin KN, Zibari GB, Lilien DL, McMillan RW, Aultman DF, McDonald JC.
Each year at least 130,000 people in the United States are diagnosed with
colorectal carcinoma. Approximately 14,000 of these patients will have liver
metastases, and 20 per cent of these patients will die from these metastases.
Surgical resection is the only possible chance for cure in patients with only
intrahepatic metastases, and extrahepatic disease is a contraindication to
glucose metabolism. Positron emission tomography (PET) allows the in vivo study
of the uptake and use of glucose in human cells. Here, we review our experience
with the use of PET imaging for the diagnosis and management of colorectal
metastases of the liver. We conducted a retrospective chart review of 14
patients undergoing PET imaging for known or suspected hepatic metastases from
colorectal carcinoma. Results of CT, magnetic resonance imaging, and PET images
were compared with pathological specimens. CT scan identified 7 lesions, and PET
identified 31 intrahepatic lesions. Of the 6 patients who underwent surgery, CT
identified 4 (20%) and PET identified 17 (85%) of the 20 intrahepatic metastases
histologically confirmed. The accuracy (number of lesions) of CT and PET was 20
per cent and 85 per cent, respectively. CT scans had a sensitivity (number of
patients) of 50 per cent, and PET had a sensitivity of 100 per cent in patients
undergoing surgical resection. PET imaging altered the management in 49 per cent
of patients. Twenty-one per cent of patients had their surgery cancelled due to
previously undiagnosed extrahepatic metastases. Twenty-one per cent of patients
had negative CT scans and underwent surgery on the basis of their PET images,
and all had histologically proven disease. One patient avoided a second-look
laparotomy when PET revealed a lesion seen on CT to be false positive. PET is an
ideal imaging modality to detect intra- and extrahepatic metastases from
colorectal carcinomas and would aid in the surgical management of these
patients.
