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FDG-PET/CT PATTERNS AND PREVALENCE OF PERITONEAL SPREAD IN OVARIAN CANCER

FDG-PET/CT PATTERNS AND PREVALENCE OF PERITONEAL SPREAD IN OVARIAN CANCER. Srour SF 1 , Bar-Shalom R 2 1 Department of Diagnostic Imaging 2 Institute of Nuclear Medicine Rambam Health Care Campus Haifa, Israel. Background.

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FDG-PET/CT PATTERNS AND PREVALENCE OF PERITONEAL SPREAD IN OVARIAN CANCER

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  1. FDG-PET/CT PATTERNS AND PREVALENCE OF PERITONEAL SPREAD IN OVARIAN CANCER Srour SF1, Bar-Shalom R2 1Department of Diagnostic Imaging 2Institute of Nuclear Medicine Rambam Health Care Campus Haifa, Israel

  2. Background • Ovarian cancer (O.C) is the second most common, and the most common cause for cancer-related death among gynecological tumors • It is responsible for more than half of gynecological mortality • Most cases revealed at a late stage • The most common secondary spread is to peritoneum and retroperitoneal L.N. • Peritoneal spread (p.s) changes the stage of tumor and affects treatment strategy and prognosis

  3. Imaging Methods • Conventional imaging methods (US, CT, MRI) are limited for detecting peritoneal spread • CT sensitivity for p.s.: 17-54%, depends on • size, place, morphology, ascitic fluid, diminished abd. fat volume, and bowel distention with contrast • PET/CT imaging for peritoneal spread is not well established, but recent studies are encouraging • PET/CT patterns of p.s. are variable and not clearly recognized

  4. Purpose To describe and characterize the incidence and patterns of peritoneal spread of ovarian cancer as demonstrated by PET/CT examination

  5. Methods • Retrospective evaluation of 150 o.c patients who underwent FDG-PET/CT. • Period: 8/2001 – 3/2007 • Parameters collected: • Normal study vs. P.S. only vs. other secondary spread • Focal vs. Diffuse P.S • Monofocal vs. Multifocal P.S • Anatomical site of spread • SUV (Standardized Uptake Value) • CT size

  6. Methods • Analysis of: • Relative incidence of each P.S. pattern • SUV average • CT average size • Relation-ship between size on CT and SUV • Present different examples of P.S patterns as seen on PET/CT.

  7. Results Exam indication • 82 (55%) – Relapse • 45 (30%) – Restaging • 23 (15%) – Evaluation after treatment • average age = 60 yrs (range: 27-81)

  8. Incidence of P.S. Patterns • Peritoneal spread was found in 45/150 (30%) • 71/150 (47%) other secondary spread was found: Retroperit. L.N, liver, lungs…(not P.S) • 34/150 (23%) were normal studies

  9. Peritoneal Spread • Three P.S. patterns were found: • Monofocal , Multifocal , and Diffuse • 24 / 45 (53%) were with P.S. only • 8/24 (33%) – Monofocal P.S • 9/24 (38%) – Multifocal P.S • 7/24 (29%) – Diffuse P.S • 21 / 45 (47%) were with P.S. and other secondary spread • 7/21 (33%) - Monofocal P.S • 13/21 (62%) - Multifocal P.S • 1/21 (5%) - Diffuse P.S

  10. Peritoneal Spread

  11. Anatomical Distribution of P.S

  12. Most Monofocal spread was to pelvis, mesentry and ant. abd. • Most multifocal spread was to pelvis, mesentry and ant. abd.and liver surface • Diffuse spread was to all the anatomical sites in the same incidence because of its widespread nature.

  13. SUV for P.S. Patterns • No significant difference was found in the SUV between the two focal spread patterns [p=0.636]: • Monofocal: suv=8.3 (range 2.9-18) • Multifocal: suv=8.8 (range 2-24.6) • In Diffuse pattern, because of its widespread nature we couldn’t accurately evaluate the SUV for this category but it seemed to be less than the focal spread.

  14. CT size for P.S. Patterns • Average size on CT in the monofocal spread was: 1.7cm (range:0.9-3cm) • Average size on CT in the Multifocal spread was: 2cm (range: 1.1-3.7cm) • We found significant relationship between SUV of peritoneal spread and average size on CT in the focal spread patterns [p=0.0001-0.004]: Big size on CT was related to high SUV

  15. Examples of P.S. in Ovarian Cancermono-focal spread to pelvis

  16. Mono-focal spread to anterior abdomen All the other focal absorption are physiologic in bowel loops

  17. Multi-focal spread to pelvis

  18. Multi-focal spread to liver surface

  19. Spread to ant. Abd. as part of diffuse spread with ascites

  20. Diffuse spread with ascites

  21. Diffuse spread on liver surface • Common in diffuse and multi-focal spread. • Difficult for diagnosis by CT scan only.

  22. Conclusion • Peritoneal spread in ovarian cancer is common (30% in our study) • As FDG-PET/CT is being an important tool for assessing these patients, familiarity with the variable peritoneal spread patterns on PET/CT is important for accurate assessment of disease status of ovarian cancer patients

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