FDG-PET for the pre-operative evaluation of colorectal liver metastases

Introduction: This study assesses the accuracy of routine whole body fluorodeoxyglucose-positron emission tomography (FDG-PET) in the pre-operative staging of patients with colorectal liver metastases (CLM). Methods: A prospective study of patients referred for hepatic resection was undertaken. Patients were staged by spiral CT and FDG-PET. The results of these investigations were considered independently. Results: Twenty-eight patients had confirmed CLM. Eleven patients had solitary CLM; 10 of whom were correctly identified by both modalities. In the remaining 17 patients, 10 had multiple CLM and seven had extrahepatic disease. FDG-PET detected all lesions (sensitivity 100%, specificity 91%). CT incorrectly diagnosed solitary CLM in five patients and failed to detect extrahepatic disease in four patients (sensitivity 47%, specificity 91%). FDG-PET resulted in altered management for 12 patients of whom seven avoided inappropriate surgery. Conclusion: FDG-PET is more sensitive and specific for pre-operative staging of CLM. FDG-PET confers clinical benefit through altered patient management.