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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
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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+ 2
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Material and methods (1)
local database of 18F FDG PET/CT scan: cutaneous MM between and inclusion of entire brain in FOV CT after IV contrast administration (contrast enhanced-CE) in the venous phase THZ CT PART WAS ACQUIRED AFTER IV CONTRAST ADMINISTRATION IN THE VENOUS PHASE 3
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Material and methods (2)
Gadolinium-enhanced MRI brain within 3 months time period of PET/CT MRI = golden standard T1,T2,FLAIR sequences Mean ΔT paired PET/CT and MRI= 15.8 days
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Material and methods (3)
Total of 49 PET/CT and subsequent MRI in 34 patients: 17 Male, 17 Female Age (years) : range , mean 52 Clinical stage grouping (AJCC): 24 IV with 12 brain (M1c) - 3 II - 7 I
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Results FDG-PET/CT: 73 lesions 3 only on PET + as hypermetabolic
36 only on CE CT + 34 on both PET and CE CT : - 8 hypermetabolic - 26 hypometabolic 3 only seen on PET as hypermetabolic spots and 36 lesions were only identified on CT 6
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MRI-Gd: 133 lesions In detecting individual brain Metastasis on FDG-PET/CT: Sensitivity and accuracy of 55% Specificity: / no true negative lesions present
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On scan basis: FDG-PET/CT : 22/49: + - MRI-Gd: 23/49 +
in 18 cases : + on PET and CE CT 4 only on CE CT + all cases confirmed by MRI - MRI-Gd: 23/49 + = PET-CT SCAN DEMONSTRATED THE PRESENCE OF BRAIN METASTASES IN 22 SCANS 8
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In determining the existence of CNS involvement in MM on FDG-PET/CT:
Sensitivity: 96% Accuracy: 98% Specificity: 100%
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1hypometabolic meta in the left frontal cortex, periferic contrast captation and perilesional oedema
02/2009 2nd milimetric lesion right frontal on MRI CECT PET Koster (melanoma at the back, lung –and brain M+) T T1 -Gd T1+Gd
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PT 1 04/2009 CECT PET/CT Increase in number and volume of M+.
Largest M+ in the right frontal cortex (max. 4,5 cm) is now hypermetabolic with perilesional hypometabolism = increase in surrounding oedema. PT 1 04/2009 CECT PET/CT Koster T T1+Gd
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PT 2 3 Known brainmetastases : in the right superior frontal, left frontal and right temporal cortex, all with surrounding oedema T1+Gd CECT PET Van eeckhout : hypermetabolic meta in right upper frontal cortex, 1 hypometabolic in the left frontal cortex and 1 hypermetabolic in the right temporal cortex. Perilesional oedema, most pronounced in the left frontal cortex. CECT PET T1+Gd
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Conclusions Including the brain in the FOV for screening or FU of MM with FDG-PET/CT is usefull. FDG-PET/CT relatively low sensitivity for identifying all individual brainM+ (55%) with the use of CE CT and acquisition in venous phase FDG-PET/CT performs well in detecting the presence of brainM+ in known MM
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Discussion Advantage of including the brain in FDG-PET/CT:
Potentially earlier detection of brainmetastases Faster and more efficient treatment Decreasing/preventing the related morbidity In case of negative FDG PET/CT and suspected clinical findings a CE MRI remains mandatory
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Selection of paired PET/CT and MRIscans: SELECTION BIAS
Overrepresentation of cases with brain metastases compared to whole melanoma population MRIscans were not performed for ALL the patients with known MM in our hospital: Routine baseline/ follow-up Suspicious clinical findings Therapeutic monitoring of cerebral M+
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