Abdominal Masses Sampled at PET/CT-guided Percutaneous Biopsy: Initial Experience with Registration of Prior PET/CT Images
Abstract
PET/CT-guided biopsy of abdominal masses performed with the aid of previously obtained PET/CT images registered with intraprocedural CT scans is feasible.
Purpose
To establish the feasibility of performing combined positron emission tomography (PET)/computed tomography (CT)-guided biopsy of abdominal masses by using previously acquired PET/CT images registered with intraprocedural CT images.
Materials and Methods
In this HIPAA-compliant institutional review board–approved study, 14 patients underwent clinically indicated percutaneous biopsy of abdominal masses (mean size, 3.3 cm; range, 1.2–5.0 cm) in the liver (n = 6), presacral soft tissue (n = 3), retroperitoneal lymph nodes (n = 2), spleen (n = 2), and pancreas (n = 1). PET/CT images obtained no more than 62 days (mean, 18.3 days) before the biopsy procedure were registered with intraprocedural CT images by using image registration software. The registered images were used to plan the procedure and help target the masses.
Results
The image registrations were technically successful in all but one patient, who had severe scoliosis. The remaining 13 biopsy procedures yielded diagnostic results, which were positive for malignancy in 10 cases and negative in three cases.
Conclusion
PET/CT–guided abdominal biopsy with use of prior PET/CT images registered with intraprocedural CT scans is feasible and may be helpful when fluorine 18 fluorodeoxyglucose–avid masses that are not seen sufficiently with nonenhanced CT are sampled at biopsy.
© RSNA, 2010
References
- 1 . FDG accumulation and tumor biology. Nucl Med Biol 1998;25(4):317–322.
- 2 . Clinical role of positron emission tomography in oncology. Lancet Oncol 2001;2(3):157–164.
- 3 . Whole-body FDG-PET imaging in the management of patients with cancer. Semin Nucl Med 2002;32(1):35–46.
- 4 . A combined PET/CT scanner for clinical oncology. J Nucl Med 2000;41(8):1369–1379.
- 5 . 18-fluorodeoxyglucose positron emission tomographic imaging in the detection and monitoring of infection and inflammation. Semin Nucl Med 2002;32(1):47–59.
- 6 . Normal variants in [18F]-fluorodeoxyglucose PET imaging. Radiol Clin North Am 2004;42(6):1063–1081, viii.
- 7 . Image-guided cancer therapy using PET/CT. Cancer J 2004;10(4):221–233.
- 8 . Integrated PET/CT: current applications and future directions. Radiology 2006;238(2):405–422.
- 9 . Comparison of multiphase CT, FDG-PET and intra-operative ultrasound in patients with colorectal liver metastases selected for surgery. Ann Surg Oncol 2007;14(2):818–826.
- 10 . FDG-PET/CT tumor segmentation-derived indices of metabolic activity to assess response to neoadjuvant therapy and progression-free survival in esophageal cancer: correlation with histopathology results. Am J Clin Oncol 2007;30(4):377–388.
- 11 . Medical image processing, analysis and visualization in clinical research. Proceedings of the IEEE Computer Society 14th Symposium on Computer-Based Medical Systems, Bethesda, Md, July 26–27, 2001; 381.
- 12 . Percutaneous biopsy of abdominal masses using 25-gauge needles. Abdom Imaging 2010;35(1):70–74.
- 13 . Abdominal and pelvic needle aspiration biopsies: can we perform them well when using small needles? Abdom Imaging 1999;24(4):321–328.
- 14 . Software approach to merging molecular with anatomic information. J Nucl Med 2004;45(suppl 1):36S–45S.
- 15 . Technologies for guidance of radiofrequency ablation in the multimodality interventional suite of the future. J Vasc Interv Radiol 2007;18(1 pt 1):9–24.
- 16 . Accurate three-dimensional registration of CT, PET, and/or MR images of the brain. J Comput Assist Tomogr 1989;13(1):20–26.
- 17 . Combined magnetic resonance imaging- and positron emission tomography-guided stereotactic biopsy in brainstem mass lesions: diagnostic yield in a series of 30 patients. J Neurosurg 2000;93(6):951–957.
- 18 . PET-CT image registration in the chest using free-form deformations. IEEE Trans Med Imaging 2003;22(1):120–128.
- 19 . CT and PET lung image registration and fusion in radiotherapy treatment planning using the chamfer-matching method. Int J Radiat Oncol Biol Phys 1999;43(4):883–891.
- 20 . Navigation with electromagnetic tracking for interventional radiology procedures: a feasibility study. J Vasc Interv Radiol 2005;16(4):493–505.
- 21 . Real-time, ultrasound-CT/MRI fusion imaging for planning, guiding, and immediately assessing percutaneous radiofrequency ablation of liver malignancies: analysis of results in 225 patients and 426 tumors (abstr). In: Radiological Society of North America scientific assembly and annual meeting program. Oak Brook, Ill: Radiological Society of North America, 2008; 552.
- 22 . A survey of medical image registration. Med Image Anal 1998;2(1):1–36.
- 23 . Automated 3-dimensional elastic registration of whole-body PET and CT from separate or combined scanners. J Nucl Med 2005;46(9):1488–1496.
- 24 . PET-CT-guided interventions in the management of FDG-positive lesions in patients suffering from solid malignancies: initial experiences. Eur Radiol 2009;19(7):1780–1785.
- 25 . Multiphasic MDCT enhancement pattern of hepatocellular carcinoma smaller than 3 cm in diameter: tumor size and cellular differentiation. AJR Am J Roentgenol 2009;193(6):W482–W489.
- 26 . Does the novel PET/CT imaging modality impact on the treatment of patients with metastatic colorectal cancer of the liver? Ann Surg 2004;240(6):1027–1034; discussion 1035–1036.
Article History
Received June 22, 2009; revision requested August 5; revision received October 21; accepted November 18; final version accepted January 20, 2010.Published online: July 2010
Published in print: July 2010