PET/CT in Malignant Melanoma: Contrast-enhanced CT Versus Plain Low-dose CT

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2011 Jan 7

PMID 21210112

Citations 14

Authors

Thomas Pfluger

Henriette Ingrid Melzer

Vera Schneider

Christian La Fougere

Eva Coppenrath

Carola Berking

Peter Bartenstein

Mayo Weiss

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this study was to evaluate the diagnostic value of contrast-enhanced CT (CECT) versus non-enhanced low-dose CT (NECT) in the staging of advanced malignant melanoma with (18)F-fluordeoxyglucose (FDG) positron emission tomography (PET)/CT.

Methods: In total, 50 (18)F-FDG PET/CT examinations were performed in 50 patients with metastasized melanoma. For attenuation correction, whole-body NECT was performed followed by diagnostic CECT with contrast agent. For the whole-body PET, (18)F-FDG was applied. Criteria for evaluation were signs of vital tumour tissue (extent of lesions, contrast enhancement, maximum standardized uptake value >2.5). Findings suspicious for melanoma were considered lesions. NECT, CECT and (18)F-FDG PET were evaluated separately, followed by combined analysis of PET/NECT and PET/CECT. Findings were verified histologically and/or by follow-up (>6 months).

Results: Overall, 232 lesions were analysed, and 151 proved to be metastases. The sensitivity of NECT, CECT, PET, PET/NECT and PET/CECT was 62, 85, 90, 97 and 100%, and specificity was 52, 63, 88, 93 and 93%, respectively. Compared to CECT, NECT obtained additional false-negative results: lymph node (n = 19) and liver/spleen metastases (n = 9). Misinterpreted physiological structures mainly caused additional false-positive findings (n = 17). In combined analysis of PET/NECT, six false-positive [other tumours (n = 2), inflammatory lymph nodes (n = 2), inflammatory lung lesion (n = 1), blood vessel (n = 1)] and five false-negative findings [liver (n = 3), spleen (n = 1), lymph node metastases (n = 1)] remained. On PET/CECT, six false-positive [inflammatory lymph nodes (n = 3), other tumours (n = 2), inflammatory lung lesion (n = 1)] and no false-negative findings occurred. However, additional false findings on PET/NECT (6 of 232) did not change staging compared to PET/CECT.

Conclusion: Our results indicate that it is justified to perform PET/NECT instead of PET/CECT for melanoma staging.

Citing Articles

Comprehensive literature review of oral and intravenous contrast-enhanced PET/CT: a step forward?.

Metrard G, Cohen C, Bailly M Front Med (Lausanne). 2024; 11:1373260.

PMID: 38566921 PMC: 10985176. DOI: 10.3389/fmed.2024.1373260.

Diagnostic Performance of [F]F-FDG Positron Emission Tomography (PET) in Non-Ophthalmic Malignant Melanoma: A Systematic Review and Meta-Analysis of More Than 10,000 Melanoma Patients.

Zamani-Siahkali N, Mirshahvalad S, Pirich C, Beheshti M Cancers (Basel). 2024; 16(1).

PMID: 38201642 PMC: 10778455. DOI: 10.3390/cancers16010215.

The Role and Potential of F-FDG PET/CT in Malignant Melanoma: Prognostication, Monitoring Response to Targeted and Immunotherapy, and Radiomics.

Filippi L, Bianconi F, Schillaci O, Spanu A, Palumbo B Diagnostics (Basel). 2022; 12(4).

PMID: 35453977 PMC: 9028862. DOI: 10.3390/diagnostics12040929.

F-FDG PET/CT versus Diagnostic Contrast-Enhanced CT for Follow-Up of Stage IV Melanoma Patients Treated by Immune Checkpoint Inhibitors: Frequency and Management of Discordances over a 3-Year Period in a University Hospital.

Le Goubey J, Lasnon C, Nakouri I, Cesaire L, de Pontville M, Nganoa C Diagnostics (Basel). 2021; 11(7).

PMID: 34359281 PMC: 8304093. DOI: 10.3390/diagnostics11071198.

Immunotherapy discontinuation - how, and when? Data from melanoma as a paradigm.

Robert C, Marabelle A, Herrscher H, Caramella C, Rouby P, Fizazi K Nat Rev Clin Oncol. 2020; 17(11):707-715.

PMID: 32636502 DOI: 10.1038/s41571-020-0399-6.

References

Nutt R . 1999 ICP Distinguished Scientist Award. The history of positron emission tomography. Mol Imaging Biol. 2003; 4(1):11-26. DOI: 10.1016/s1095-0397(00)00051-0. View

Mottaghy F, Sunderkotter C, Schubert R, Wohlfart P, Blumstein N, Neumaier B . Direct comparison of [18F]FDG PET/CT with PET alone and with side-by-side PET and CT in patients with malignant melanoma. Eur J Nucl Med Mol Imaging. 2007; 34(9):1355-64. DOI: 10.1007/s00259-006-0358-1. View

Rosenbaum S, Lind T, Antoch G, Bockisch A . False-positive FDG PET uptake--the role of PET/CT. Eur Radiol. 2005; 16(5):1054-65. DOI: 10.1007/s00330-005-0088-y. View

Antoch G, Saoudi N, Kuehl H, Dahmen G, Mueller S, Beyer T . Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol. 2004; 22(21):4357-68. DOI: 10.1200/JCO.2004.08.120. View

Czernin J, Allen-Auerbach M, Schelbert H . Improvements in cancer staging with PET/CT: literature-based evidence as of September 2006. J Nucl Med. 2007; 48 Suppl 1:78S-88S. View

Garbe C, Hauschild A, Volkenandt M, Schadendorf D, Stolz W, Reinhold U . Evidence and interdisciplinary consense-based German guidelines: diagnosis and surveillance of melanoma. Melanoma Res. 2007; 17(6):393-9. DOI: 10.1097/CMR.0b013e3282f05039. View

Antoch G, Forsting M . [How much CT does PET/CT need?]. Nuklearmedizin. 2004; 43(5):141-2. DOI: 10.1267/nukl04050141. View

Antoch G, Freudenberg L, Beyer T, Bockisch A, Debatin J . To enhance or not to enhance? 18F-FDG and CT contrast agents in dual-modality 18F-FDG PET/CT. J Nucl Med. 2004; 45 Suppl 1:56S-65S. View

Horn J, Sjostrand H, Lock-Andersen J, Loft A . [PET scanning for malignant melanoma and positive sentinel node diagnostics]. Ugeskr Laeger. 2010; 172(15):1126-30. View

10.

Krug B, Crott R, Roch I, Lonneux M, Beguin C, Baurain J . Cost-effectiveness analysis of FDG PET-CT in the management of pulmonary metastases from malignant melanoma. Acta Oncol. 2010; 49(2):192-200. DOI: 10.3109/02841860903440254. View

11.

Hany T, Steinert H, Goerres G, Buck A, von Schulthess G . PET diagnostic accuracy: improvement with in-line PET-CT system: initial results. Radiology. 2002; 225(2):575-81. DOI: 10.1148/radiol.2252011568. View

12.

Veit-Haibach P, Vogt F, Jablonka R, Kuehl H, Bockisch A, Beyer T . Diagnostic accuracy of contrast-enhanced FDG-PET/CT in primary staging of cutaneous malignant melanoma. Eur J Nucl Med Mol Imaging. 2009; 36(6):910-8. DOI: 10.1007/s00259-008-1049-x. View

13.

Rodriguez-Vigil B, Gomez-Leon N, Pinilla I, Hernandez-Maraver D, Coya J, Martin-Curto L . PET/CT in lymphoma: prospective study of enhanced full-dose PET/CT versus unenhanced low-dose PET/CT. J Nucl Med. 2006; 47(10):1643-8. View

14.

Brix G, Lechel U, Glatting G, Ziegler S, Munzing W, Muller S . Radiation exposure of patients undergoing whole-body dual-modality 18F-FDG PET/CT examinations. J Nucl Med. 2005; 46(4):608-13. View

15.

Reinhardt M, Joe A, Jaeger U, Huber A, Matthies A, Bucerius J . Diagnostic performance of whole body dual modality 18F-FDG PET/CT imaging for N- and M-staging of malignant melanoma: experience with 250 consecutive patients. J Clin Oncol. 2006; 24(7):1178-87. DOI: 10.1200/JCO.2005.03.5634. View

16.

Jimenez-Requena F, Delgado-Bolton R, Fernandez-Perez C, Gambhir S, Schwimmer J, Perez-Vazquez J . Meta-analysis of the performance of (18)F-FDG PET in cutaneous melanoma. Eur J Nucl Med Mol Imaging. 2009; 37(2):284-300. PMC: 2886141. DOI: 10.1007/s00259-009-1224-8. View

17.

Kuehl H, Antoch G . How much CT do we need for PEt/CT? A radiologist's perspective. Nuklearmedizin. 2006; 44 Suppl 1:S24-31. View

18.

Buzaid A, Tinoco L, Ross M, Legha S, Benjamin R . Role of computed tomography in the staging of patients with local-regional metastases of melanoma. J Clin Oncol. 1995; 13(8):2104-8. DOI: 10.1200/JCO.1995.13.8.2104. View

19.

Rinne D, Baum R, Hor G, Kaufmann R . Primary staging and follow-up of high risk melanoma patients with whole-body 18F-fluorodeoxyglucose positron emission tomography: results of a prospective study of 100 patients. Cancer. 1998; 82(9):1664-71. DOI: 10.1002/(sici)1097-0142(19980501)82:9<1664::aid-cncr11>3.0.co;2-2. View

20.

Krug B, Dietlein M, GROTH W, Stutzer H, Psaras T, Gossmann A . Fluor-18-fluorodeoxyglucose positron emission tomography (FDG-PET) in malignant melanoma. Diagnostic comparison with conventional imaging methods. Acta Radiol. 2000; 41(5):446-52. DOI: 10.1080/028418500127345668. View