Published Online:https://doi.org/10.1148/radiol.13121462

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.

Purpose

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.

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.

Conclusion

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

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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