Imaging methods ERUS CT NMR FGD-PET scan Radioimmunoscintigraphy Bone scintigraphy Most types of local recurrence even from beginning extraluminal ! Follow-up

Sensitivity of different imaging methods for the detection of the liver metastases Screen ing techni que No of patient s Patient s with liver met. Positiv e result (n) True positiv e (n) Negati ve result (n) True negati ve (n) Sensitiv ity (95% CI) Specifi city (95% CI) CT ,670,91 MR ,640,91 US ,430,96 C. Glover, DCR 2002.

CT vs NMR imaging Follow-up

CT vs NMR imaging Follow-up

Sensitivity and specificity of combinaton of different imaging methods for the detection of the liver metastases C. Glover, DCR *DPI ultrasound Doppler assessment of hepatic arterial and portal venous blood flow *HPI isotope assessment of hepatic arterial and portal venous blood flow

FDG-PET scan- local recurrence of RC Schiepers C. Eur J Surg Oncol FDG-PET scan- successful in distinguishing tumor from scar tissue Evidence of LR Follow-up

CT vs. FDG-PET scan specificity (%)sensitivity (%) FDG-PET scan9892 CT6072 Schiepers C. Eur J Surg Oncol Follow-up Local recurrence of RC

Indications for FDG-PET scan  Patients planned for curative salvage surgery  Patients with inconclusive or conflicting results from conventional imaging methods  Patients with all conventional tests negative and elevated CEA levels

Diagnostic tests Summary  Combination of tests has higher sensitivity and specificity than any individual test  There's no sufficient data to recommend optimal combination of tests and frequency of follow-up visits Follow-up