Low-dose non-enhanced CT versus full-dose contrast-enhanced CT in integrated PET/CT scans for diagnosing ovarian cancer recurrence
Section snippets
Objective
In approximately 20–30% of patients with early-stage ovarian cancer and 50–75% of those with advanced disease who obtain a complete response after therapy, disease will ultimately recur [1]. Few formal guidelines exist on the surveillance of these patients, and the type and timing of examinations to perform. The clinical follow-up generally includes measurement of the serum cancer antigen CA-125 level, physical examination, and imaging examinations.
Computed tomography (CT) and magnetic
Patients
One hundred and twenty patients (age range 32–87 years; mean 59 years) who had undergone treatment for histopathologically proven ovarian cancer underwent PET/CT examinations with intravenous contrast agent for suspected recurrence at PET Center, Institute of Biological Research and Innovation between December 2007 and July 2011 were included in this study. Informed consent was obtained from each patient after procedures were fully explained. Further details of these patients and their
Patient-based analysis
In 46 (38.3%) of the 120 patients, recurrence and/or distant metastasis was confirmed by pathologic examination and clinical follow-up study of imaging modality. In the other 74 patients (61.7%), no recurrence was confirmed by clinical follow-up study of tumor markers and imaging modality for periods than 6 months. The scales of detecting 46 patients with recurrence were N:4, E:2, and P:40 for PET/ceCT and N:4, E:6, and P:36 for PET/ldCT (Table 2). Four patients with equivocal findings by
Discussion
In our study, PET/ceCT is a more statistically accurate imaging modality for assessing ovarian cancer recurrence than PET/ldCT, reducing equivocal interpretations. Our results showed that patient-based sensitivity, specificity, and accuracy of PET/ceCT was 86.9%, 95.9%, and 92.5%, respectively, whereas those of PET/ldCT were 78.3%, 95.0%, and 88.3%, respectively. Moreover, with PET/ceCT, the proportion of equivocal findings on the per patient basis decreased by 4.2% (from 7 of 120 patients to 2
Conclusion
In conclusion, integrated FDG-PET/ceCT reduces the frequency of equivocal interpretations observed on PET/ldCT scan and is a more accurate imaging modality with higher confidence for assessing ovarian cancer recurrence than PET/ldCT. PET/ceCT may be a real “one-stop-shopping” examination.
Acknowledgments
We thank Hiroyoshi Okajima, Keita Miyamoto, Eiji Takeda, and Kazuhiro Kubo for their excellent technical assistance and generous support.
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