A prospective trial for the evaluation of esophageal cancer patients: fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) vs contrast enhancement (c.e). CT vs. FDG PET/c.e.CT

Purpose: We reported the preliminary data about the comparison of diagnostic performance among PET/CT, c.e.CT and PET/c.e.CT in oesophageal cancer patients. Methods and Materials: 60 EC patients (46 male, 62±12 years) who underwent basal PET/CT plus c.e.CT in a single session, were recruited. After 60 min from the injection of FDG, a whole body PET/CT scan was acquired. At the end of standard acquisition, a neck-thorax-abdomen c.e. CT was performed; in particular, three c.e. phases for the liver evaluation were made. Three specialised physicians (two radiologists and two nuclear medicine specialists) read the images, separately. The diagnostic performances of PET/CT, PET/c.e.CT and c.e.CT were evaluated by using the standard method and then compared with clinical staging (by patient-based analysis). Results: 60 patients performed both PET/CT and c.e.CT while 57 of them had all three scans. The imaging co-registration (PET and c.e.CT) was good in 88% of patients, discrete in 7% and scarce in only 5%. The agreement among the three scans was present in 35% of subjects. In the remnant 65% of patients, c.e.CT demonstrated more lymph node metastases than both PET/CT and PET/c.e.CT (15 and 11%, respectively), similarly PET/c.e.CT showed more loco-regional/distant lymph nodes and distant metastases than PET/CT (increase in positive rate=30%). The clinical staging was recovered in 28 (41%) patients. The positive predictive value of PET/c.e.CT was higher than PET/CT and c.e.CT for the identification of loco-regional/distant lymph nodes and distant metastases (81 vs.78% and 70%, respectively). Conclusion: In EC patients, FDG PET/c.e.CT represents an accurate and feasible method for recognising a major number of pathological findings in comparison with PET/CT and c.e.CT.