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The use of a split-dose technique for percutaneous ablation with fluorine 18 fluorodeoxyglucose (FDG) PET guidance facilitates targeting of FDG-avid lesions and may provide confirmation of treatment effectiveness.


To describe a split-dose technique for fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT)-guided ablation that permits both target localization and evaluation of treatment effectiveness.

Materials and Methods

Institutional review board approved the study with a waiver of consent. From July to December 2011, 23 patients (13 women, 10 men; mean age, 59 years; range, 35–87 years) with 29 FDG-avid tumors (median size, 1.4 cm; range, 0.6–4.4 cm) were targeted for ablation. The location of the lesion was the liver (n = 23), lung (n = 4), adrenal gland (n = 1), and thigh (n = 1). Radiofrequency ablation was performed in 17 lesions; microwave ablation, in six; irreversible electroporation, in five; and cryoablation, in one. The pathologic condition of the tumor was metastatic colorectal adenocarcinoma in 18 lesions, primary hepatocellular carcinoma in one lesion, and a variety of metastatic tumors in the remaining 10 lesions. A total of 4 mCi (148 MBq) of FDG was administered before the procedure for localization and imaging guidance. At completion of the ablation, an additional 8 mCi (296 MBq) of FDG was administered to assess ablation adequacy. Results of subsequent imaging follow-up were used to determine if postablation imaging after the second dose of FDG reliably helped predict complete tumor ablation. Descriptive statistics were used to summarize the results.


Twenty-eight of 29 (97%) ablated lesions showed no residual FDG activity after the second intraprocedural FDG dose. One patient with residual activity underwent immediate biopsy that revealed residual viable tumor and was immediately re-treated. Follow-up imaging at a median of 155 days (range, 92–257 days) after ablation showed local recurrences in two (7%) lesions that were originally negative at postablation PET.


Split-dose FDG PET/CT may be a useful tool to provide both guidance and endpoint evaluation, allowing an opportunity for repeat intervention if necessary. Further work is necessary to validate these concepts.

© RSNA, 2013


  • 1 Solomon SB, Silverman SG. Imaging in interventional oncology. Radiology 2010;257(3): 624–640. LinkGoogle Scholar
  • 2 Venkatesan AM, Kadoury S, Abi-Jaoudeh N, et al.. Real-time FDG PET guidance during biopsies and radiofrequency ablation using multimodality fusion with electromagnetic navigation. Radiology 2011;260(3):848–856. LinkGoogle Scholar
  • 3 Ayav A, Germain A, Marchal F, et al.. Radiofrequency ablation of unresectable liver tumors: factors associated with incomplete ablation or local recurrence. Am J Surg 2010;200(4):435–439. Crossref, MedlineGoogle Scholar
  • 4 Kim KW, Lee JM, Klotz E, et al.. Safety margin assessment after radiofrequency ablation of the liver using registration of preprocedure and postprocedure CT images. AJR Am J Roentgenol 2011;196(5):W565–W572. Crossref, MedlineGoogle Scholar
  • 5 Kim YS, Lee WJ, Rhim H, Lim HK, Choi D, Lee JY. The minimal ablative margin of radiofrequency ablation of hepatocellular carcinoma (> 2 and < 5 cm) needed to prevent local tumor progression: 3D quantitative assessment using CT image fusion. AJR Am J Roentgenol 2010;195(3):758–765. Crossref, MedlineGoogle Scholar
  • 6 Kim YS, Rhim H, Cho OK, Koh BH, Kim Y. Intrahepatic recurrence after percutaneous radiofrequency ablation of hepatocellular carcinoma: analysis of the pattern and risk factors. Eur J Radiol 2006;59(3):432–441. Crossref, MedlineGoogle Scholar
  • 7 Meloni MF, Andreano A, Franza E, Passamonti M, Lazzaroni S. Contrast enhanced ultrasound: should it play a role in immediate evaluation of liver tumors following thermal ablation? Eur J Radiol 2012;81(8):e897–e902. Crossref, MedlineGoogle Scholar
  • 8 Vilar VS, Goldman SM, Ricci MD, et al.. Analysis by MRI of residual tumor after radiofrequency ablation for early stage breast cancer. AJR Am J Roentgenol 2012;198(3):W285–W291. Crossref, MedlineGoogle Scholar
  • 9 Deandreis D, Leboulleux S, Dromain C, et al.. Role of FDG PET/CT and chest CT in the follow-up of lung lesions treated with radiofrequency ablation. Radiology 2011; 258(1):270–276. LinkGoogle Scholar
  • 10 Singnurkar A, Solomon SB, Gönen M, Larson SM, Schöder H. 18F-FDG PET/CT for the prediction and detection of local recurrence after radiofrequency ablation of malignant lung lesions. J Nucl Med 2010;51(12):1833–1840. Crossref, MedlineGoogle Scholar
  • 11 Okuma T, Okamura T, Matsuoka T, et al.. Fluorine-18-fluorodeoxyglucose positron emission tomography for assessment of patients with unresectable recurrent or metastatic lung cancers after CT-guided radiofrequency ablation: preliminary results. Ann Nucl Med 2006;20(2):115–121. Crossref, MedlineGoogle Scholar
  • 12 Liu ZY, Chang ZH, Lu ZM, Guo QY. Early PET/CT after radiofrequency ablation in colorectal cancer liver metastases: is it useful? Chin Med J (Engl) 2010;123(13):1690–1694. MedlineGoogle Scholar
  • 13 Schoellnast H, Larson SM, Nehmeh SA, Carrasquillo JA, Thornton RH, Solomon SB. Radiofrequency ablation of non-small-cell carcinoma of the lung under real-time FDG PET CT guidance. Cardiovasc Intervent Radiol 2011;34(Suppl 2):S182–S185. Crossref, MedlineGoogle Scholar
  • 14 Sainani NI, Shyn PB, Tatli S, Morrison PR, Tuncali K, Silverman SG. PET/CT-guided radiofrequency and cryoablation: is tumor fluorine-18 fluorodeoxyglucose activity dissipated by thermal ablation? J Vasc Interv Radiol 2011;22(3):354–360. Crossref, MedlineGoogle Scholar
  • 15 Eng J. Sample size estimation: how many individuals should be studied? Radiology 2003;227(2):309–313. LinkGoogle Scholar
  • 16 Kuvshinoff BW, Ota DM. Radiofrequency ablation of liver tumors: influence of technique and tumor size. Surgery 2002;132(4):605–611; discussion 611–612. Crossref, MedlineGoogle Scholar
  • 17 Curley SA. Radiofrequency ablation of malignant liver tumors. Ann Surg Oncol 2003;10(4):338–347. Crossref, MedlineGoogle Scholar
  • 18 Pua BB, Sofocleous CT. Imaging to optimize liver tumor ablation. Imaging Med 2010;2(4):433–443. CrossrefGoogle Scholar
  • 19 Wang X, Sofocleous CT, Erinjeri JP, et al.. Margin size is an independent predictor of local tumor progression after ablation of colon cancer liver metastases. Cardiovasc Intervent Radiol 2013;36(1):166–175. Crossref, MedlineGoogle Scholar
  • 20 Sofocleous CT, Nascimento RG, Petrovic LM, et al.. Histopathologic and immunohistochemical features of tissue adherent to multitined electrodes after RF ablation of liver malignancies can help predict local tumor progression: initial results. Radiology 2008;249(1):364–374. LinkGoogle Scholar
  • 21 Sofocleous CT, Garg S, Petrovic LM, et al.. Ki-67 is a prognostic biomarker of survival after radiofrequency ablation of liver malignancies. Ann Surg Oncol 2012;19(13):4262–4269. Crossref, MedlineGoogle Scholar
  • 22 Weight CJ, Kaouk JH, Hegarty NJ, et al.. Correlation of radiographic imaging and histopathology following cryoablation and radio frequency ablation for renal tumors. J Urol 2008;179(4):1277–1281; discussion 1281–1283. Crossref, MedlineGoogle Scholar
  • 23 Lokken RP, Gervais DA, Arellano RS, et al.. Inflammatory nodules mimic applicator track seeding after percutaneous ablation of renal tumors. AJR Am J Roentgenol 2007;189(4):845–848. Crossref, MedlineGoogle Scholar
  • 24 Solomon SB. Can imaging be used to assess treatment success after ablation of renal tumors? Nat Clin Pract Urol 2008;5(12):642–643. Crossref, MedlineGoogle Scholar
  • 25 Avril NE, Weber WA. Monitoring response to treatment in patients utilizing PET. Radiol Clin North Am 2005;43(1):189–204. Crossref, MedlineGoogle Scholar
  • 26 Edge SBByrd DRCompton CCet al., eds. AJCC cancer staging manual 7th ed. New York, NY: Springer-Verlag, 2010. Google Scholar
  • 27 Duncan JR, Balter S, Becker GJ, et al.. Optimizing radiation use during fluoroscopic procedures: proceedings from a multidisciplinary consensus panel. J Vasc Interv Radiol 2011;22(4):425–429. Crossref, MedlineGoogle Scholar
  • 28 Cerqueira MD, Lawrence A. Nuclear cardiology update. Radiol Clin North Am 2001;39(5):931–946, vii–viii. Crossref, MedlineGoogle Scholar
  • 29 Ryan ER, Thornton RH, Sofocleous CT, et al.. PET CT guided interventions: personnel radiation dose. Cardiovasc Intervent Radiol 2012 Nov 15. [Epub ahead of print] MedlineGoogle Scholar
  • 30 Park MH, Rhim H, Kim YS, Choi D, Lim HK, Lee WJ. Spectrum of CT findings after radiofrequency ablation of hepatic tumors. RadioGraphics 2008;28(2):379–390; discussion 390–392. LinkGoogle Scholar
  • 31 la Fougère C, Suchorska B, Bartenstein P, Kreth FW, Tonn JC. Molecular imaging of gliomas with PET: opportunities and limitations. Neuro-oncol 2011;13(8):806–819. Crossref, MedlineGoogle Scholar
  • 32 Schelbert HR, Hoh CK, Royal HD, et al.. Procedure guideline for tumor imaging using fluorine-18-FDG. Society of Nuclear Medicine. J Nucl Med 1998;39(7):1302–1305. Google Scholar
  • 33 Thie JA, Hubner KF, Smith GT. Optimizing imaging time for improved performance in oncology PET studies. Mol Imaging Biol 2002;4(3):238–244. Crossref, MedlineGoogle Scholar

Article History

Received July 28, 2012; revision requested October 1; revision received December 5; accepted December 20; final version accepted January 10, 2013.
Published online: July 2013
Published in print: July 2013