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Utility and accuracy of 18F FDG-PET/CT in the detection of cerebral melanoma metastases

Utility and accuracy of 18F FDG-PET/CT in the detection of cerebral melanoma metastases. Sylvia Deryk , Bart Neyns , Mark De Ridder , Frederik Vandenbroucke , Axel Bossuyt , Christian Vanhove , Hendrik Everaert. Objective.

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Utility and accuracy of 18F FDG-PET/CT in the detection of cerebral melanoma metastases

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  1. Utility and accuracy of 18F FDG-PET/CT in the detection of cerebralmelanoma metastases Sylvia Deryk, Bart Neyns, Mark De Ridder, FrederikVandenbroucke, Axel Bossuyt, Christian Vanhove, HendrikEveraert

  2. Objective To investigate the benefit of including the brain in the FOV in FDG-PET/CT scan in MM Sensitivity, specificity and accuracy in the identification of brainM+

  3. Material and methods (1) local database of 18F FDG PET/CT scan: cutaneous MM between 1-4-2008 and 30-11-2009 inclusion of entirebrain in FOV CT after IV contrast administration (contrast enhanced-CE) in the venousphase

  4. Material and methods (2) • Gadolinium-enhancedMRI brainwithin 3 monthstime period of PET/CT • MRI = golden standard • T1,T2,FLAIR sequences • Mean ΔT paired PET/CT and MRI= 15.8 days

  5. Material and methods (3) • Total of 49 PET/CT and subsequent MRI in 34 patients: • 17 Male, 17 Female • Age (years) : range 26-80 , mean 52 • Clinical stage grouping (AJCC): • 24 IV with 12 brain (M1c) - 3 II - 7 I

  6. Results FDG-PET/CT: 73 lesions 3 onlyon PET + as hypermetabolic 36 onlyon CE CT + 34 onboth PET and CE CT : - 8 hypermetabolic - 26 hypometabolic

  7. MRI-Gd: 133 lesions  In detectingindividualbrainMetastasison FDG-PET/CT: • Sensitivity and accuracy of 55% • Specificity: /  notruenegativelesions present

  8. On scan basis: FDG-PET/CT : 22/49: + in 18 cases : + on PET and CE CT 4 onlyon CE CT +  all cases confirmedby MRI - MRI-Gd: 23/49 +

  9. In determiningthe existence of CNS involvement in MM onFDG-PET/CT: • Sensitivity: 96% • Accuracy: 98% • Specificity: 100%

  10. 1hypometabolic meta in the left frontal cortex, periferic contrast captation and perilesionaloedema PT 1 02/2009 2ndmilimetriclesion right frontalon MRI CECTPET T2 T1 -Gd T1+Gd

  11. Increase in number and volume of M+. Largest M+ in the right frontal cortex (max.  4,5 cm) is now hypermetabolic with perilesionalhypometabolism = increase in surrounding oedema. PT 1 04/2009 CECT PET/CT T2 T1+Gd

  12. PT 2 3 Known brainmetastases : in the right superior frontal, left frontal and right temporal cortex, all with surrounding oedema T1+Gd CECT PET CECT PET T1+Gd

  13. Conclusions • Including the brain in the FOV forscreeningor FU of MM with FDG-PET/CT is usefull. • FDG-PET/CT relatively low sensitivityforidentifying all individualbrainM+ (55%) • with the use of CE CT and acquisition in venousphase FDG-PET/CT performswell in detecting the presence of brainM+ in known MM

  14. Discussion Advantage of including the brain in FDG-PET/CT: Potentiallyearlierdetection of brainmetastases Faster and more efficienttreatment Decreasing/preventing the relatedmorbidity • In case of negative FDG PET/CT and suspectedclinicalfindings a CE MRI remainsmandatory

  15. Selection of paired PET/CT and MRIscans: SELECTION BIAS Overrepresentationof cases withbrain metastases compared to wholemelanomapopulation MRIscanswerenotperformedfor ALL the patientswithknown MM in ourhospital: Suspiciousclinicalfindings Routine baseline/ follow-up Therapeuticmonitoring of cerebral M+

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