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Benefits of 18F-FDG PET/CT for the preoperative characterisation or staging of disease in the ampullary and duodenal papillary

  • Nuclear Medicine
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Diagnosing ampullary and duodenal papillary carcinomas (ADPCs) is challenging. In the present study, we investigated the application value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the preoperative evaluation of these tumours.

Methods

18F-FDG PET/CT images of 58 patients with ADPC and 28 patients with benign disease were retrospectively analysed. Preoperative 18F-FDG PET/CT was compared to contrast-enhanced (CE) CT and magnetic resonance imaging (MRI) in terms of diagnostic efficacy, certainty, staging and impact on treatment decisions.

Results

18F-FDG PET/CT showed a high sensitivity (93.1%) and a medium specificity (78.6%) for diagnosing ADPC. Compared to CE CT/MRI, 18F-FDG PET/CT had a higher diagnostic specificity (78.6 vs. 35.7%, p = 0.001) but a similar sensitivity (93.1 vs. 89.6%, p = 0.508). 18F-FDG PET/CT provided a much higher diagnostic certainty than CE CT/MRI (definite reports, 88.4 vs. 50.0%, χ2 = 29.698, p < 0.001), especially for small tumours ≤ 1.5 cm, and found distant metastases in five patients. The 18F-FDG PET/CT findings affected the treatment plans of 11 patients and improved the confidence in the diagnoses of 28 patients.

Conclusions

The present study demonstrated that 18F-FDG PET/CT can supplement CE CT/MRI to provide a more accurate diagnosis for ADPC, and thus, plays an important role in the decision-making process before complicated pancreaticoduodenectomy procedures.

Key Points

• It is a challenge for CT and MRI to diagnose ampullary carcinoma, especially at their early stage.

• Our study demonstrated that the benefit of PET/CT was improving the diagnostic confidence for ampullary and duodenal papillary carcinomas.

• 18 F-FDG PET/CT can change the treatment decision for ampullary and duodenal papillary carcinomas.

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Abbreviations

18F-FDG:

18F-fluorodeoxyglucose

ADPC:

Ampullary and duodenal papillary carcinomas

CE:

Contrast-enhanced

CBD:

Common bile duct

CT:

Computed tomography

ERCP:

Endoscopic retrograde cholangiopancreatography

EUS:

Duodenal endoscopy with endoscopic ultrasound

MRCP:

Magnetic resonance cholangiopancreatography

MRI:

Magnetic resonance imaging

OSEM:

Ordered subset expectation maximisation

PACS:

Picture Archiving and Communication Systems

PD:

Pancreaticoduodenectomy

PET/CT:

Positron emission tomography/computed tomography

ROI:

Region of interest

SUVmax:

Maximum standardised uptake value

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Acknowledgements

We thank our colleagues at Nanfang PET Center who manufactured the radiopharmaceuticals and performed the PET/CT scans. We also express our appreciation to our colleagues at the Department of Hepatobiliary Surgery and Pathology in Nanfang Hospital who provided the follow-up data and pathologic diagnosis.

Funding

This study has received funding from the National Natural Science Foundation Project of China (81371591, 81873905).

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Author notes

  1. Guanghua Wen and Jiamei Gu contributed equally to this work.

Authors and Affiliations

  1. Nanfang PET Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong Province, China

    Guanghua Wen, Jiamei Gu, Wenlan Zhou, Lijuan Wang, Ying Tian, Ye Dong, Lilan Fu & Hubing Wu

  2. Department of Nuclear Medicine, **hua Municipal Central Hospital, **hua Hospital of Zhejiang University, **hua, Zhejiang, China

    Guanghua Wen

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  1. Guanghua Wen
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Correspondence to Hubing Wu.

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The scientific guarantor of this publication is Hubing Wu.

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The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

The Institutional Review Board of Nanfang Hospital at Southern Medical University approved the present retrospective study and waived the requirement for written informed consent because of the retrospective nature of the study.

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Institutional Review Board approval was obtained.

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• retrospective

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• performed at one institution

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Wen, G., Gu, J., Zhou, W. et al. Benefits of 18F-FDG PET/CT for the preoperative characterisation or staging of disease in the ampullary and duodenal papillary. Eur Radiol 30, 5089–5098 (2020). https://doi.org/10.1007/s00330-020-06864-z

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