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Selection of Patients for Resection of Hepatic Metastases: Improved Detection of Extrahepatic Disease with FDG PET¹

¹ From the Departments of Radiology (I.A.Z., J.R., S.S.) and Nuclear Medicine (S.J.S., G.C., C.N.), McMaster University Medical Centre, 1200 Main St W, Hamilton, Ontario, Canada L8N 3Z5. Presented as an education exhibit at the 2000 RSNA scientific assembly. Received January 31, 2001; revision requested February 26 and received March 28; accepted April 3. Address correspondence to I.A.Z. (e-mail: ianzealley@moose-mail.com).

A rapidly emerging clinical application of positron emission tomography (PET) is the detection of tumor tissue at whole-body studies performed with the glucose analogue 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG). High rates of recurrence after partial hepatic resection in patients with colorectal cancer liver metastases indicate that current presurgical imaging strategies are failing to show extrahepatic tumor deposits. Although FDG PET cannot match the anatomic resolution of conventional imaging techniques in the liver and the lungs, it is particularly useful for identification and characterization of extrahepatic disease. FDG PET can show foci of metastatic disease that may not be apparent at conventional anatomic imaging and can aid in the characterization of indeterminate soft-tissue masses. Several sources of benign and physiologic increased activity at FDG PET emphasize the need for careful correlation with findings of other imaging studies and clinical findings. FDG PET can improve the selection of patients for partial hepatic resection and thereby reduce the morbidity and mortality associated with inappropriate surgery.

Index Terms: Fluorine, radioactive • Liver neoplasms, PET, 761.12163 • Liver neoplasms, metastases, 761.3327

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