BACKGROUND Tumours of the hepatobiliary system comprise a heterogeneous group of malignant lesions including primary and secondary liver tumours, cholangiocarcinoma and gallbladder carcinoma A variety of imaging modalities are available to image these tumours including ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP) and more invasive techniques like endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC). Functional imaging with positron emission tomography (PET) using 18Fluorine-fluorodeoxyglucose (FDG) allows assessment of the metabolic activity of these tumours. Integrated PET/CT, combining functional...

PATIENT GROUP 108 patients with potentially radically treatable hepatobiliary malignancy were referred for FDG PET/CT over a 2 year period at our large tertiary referral centre. These included 75 patients with colorectal liver metastases, 23 patients with cholangiocarcinoma and 10 patients with gallbladder carcinoma.IMAGING All patients were discussed at a hepatobiliary multidiscipliniary meeting (MDT) prior to and following the PET/CT being performed. The pre-PET/CT management plan was recorded in the MDT notes. All patients had CT performed prior to PET/CT and MRI performed prior to...

COLORECTAL LIVER METASTASESFDG PET/CT detected additonal sites of diseasein 32 of 75 patients (43%) with colorectal carcinoma liver metastases: 11 patients (15%) upstaged by nodal disease (Figure 1) 20 patients (27%) upstageddueto metastatic disease 1 patient (1%) due to a synchronous malignancy PET/CT down-staged disease in 3 patients (4%).There was a change to planned treatment following PET/CT in 14 patients (19%).CHOLANGIOCARCINOMAFDG PET/CT detected additional sites of disease in 8 of 23 patients (35%) with cholangiocarcinoma: 1 patient (5%) upstaged by nodal disease 7 patients (30%)...

Our study has demonstrated that FDG PET/CT can detect additional sites of metastatic disease, predominantly extrahepatic which maybe occult on conventional imaging. For colorectal liver metastases, PET/CT detected additonal sites of disease in 43% of cases with a change in management in 17% of patients. Previous reports suggest the detection of extrahepatic disease may alter management in up to 32% of patients with longer 3 year survival rates in those undergoing curvative resection following PET/CT [3-5]. Cholangiocarcinomas may show variable FDG avidity, greater in peripheral...

KEY REFERENCESDelbeke Dand Martin WH. Update of PET and PET/CT for hepatobiliary and pancreatic malignancies. HPB 2005; 7:166-179 Gambhir SS et al. A tabulated summary of the FDG PET literature. J Nucl Med 2001; 42(suppl):9S-12S Strauss LG, Dimitrakopoulou-Strauss A. Can PET-CT replaced contrast enhanced CT for imaging liver metastases. Eur J Nucl Med Mol Imag 2007; 34:1202-5Strasberg SM et al. Survival of patients evaluated by FDG-PET before hepatic resection for metastatic colorectal carcinoma: a prospective database study. Ann Surg 2001; 233:293-9Cohade C et al. Direct...

Chirag N PatelDepartments of Radiology and Nuclear MedicineOxford Radcliffe Hospitals NHS [email protected] F ScarsbrookDepartments of Radiology and Nuclear Medicine,Leeds Teaching Hospitals NHS Trust,[email protected]