ABSTRACT
BACKGROUND: Management of colorectal liver metastasis (CRLM) is evolving but surgery remains the most effective treatment in improving survival. Optimal preoperative patient selection is important and semiquantitative F-18 fluorodeoxyglucose positron emission tomography (PET) parameters may provide valuable prognostic information. METHODS: Sixty-one patients with solitary CRLM as first site of distant dissemination and preoperatively staged with PET were retrospectively studied. Various semiquantitative PET parameters, pathological size of the hepatic lesion and clinical variables were correlated with survival outcome. The data were analyzed with nonparametric Kruskal-Wallis test and univariate Cox regression. Kaplan-Meier estimates of overall survival and disease-free survival (DFS) were log-rank tested. RESULTS: Mean follow-up for the 61 subjects was 48 months. The 1- and 3-year survival rates were 98.7% and 72.2%. The median DFS was 16 months with recurrence in 10 (16.4%) patients following surgery. Univariate analysis found a statistically significant increased risk of death for higher mean PET tumor diameter (hazard ratio [HR] 2.95, P = 0.014), mean metabolic tumor volume (HR 3.0, P = 0.009) and median pathological size of hepatic lesion (HR 2.97, P = 0.022). Maximum standardized uptake value of the liver metastasis and calculated standardized uptake value ratio between tumor and normal liver parenchyma (tumor background ratio) were not predictive of overall survival. None of the PET parameters or clincopathological variables statistically correlated with DFS. CONCLUSION: Semiquantitative PET variables are potentially valuable prognostic biomarkers in CRLM. Volumetric data like metabolic tumor volume enable better estimation of tumor burden and its utility may improve preoperative risk stratification and optimize outcome.
Subject(s)
Colorectal Neoplasms/diagnostic imaging , Fluorodeoxyglucose F18 , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/secondary , Adult , Aged , Aged, 80 and over , Colorectal Neoplasms/metabolism , Colorectal Neoplasms/pathology , Disease-Free Survival , Female , Humans , Liver Neoplasms/pathology , Male , Middle Aged , Positron-Emission Tomography/methods , Prognosis , Retrospective Studies , Survival Rate , Treatment Outcome , Tumor BurdenABSTRACT
We present a case of primary cardiac lymphoma (PCL) that was initially manifest through syncopal episodes. In the diagnostic evaluation, positron emission tomography combined with computed tomography (PET-CT) made a significant contribution--beyond that which would have been possible if only conventional imaging modalities such as magnetic resonance imaging (MRI) and transthoracic echocardiography (TTE) were utilized--and played a major role in follow-up.
