Fusion Image of Positron Emission Tomography and
Computed Tomography for the Diagnosis of Local
Recurrence of Rectal Cancer
Hiroki Fukunaga, MD,
Mitsugu Sekimoto, MD, PhD,
Masataka Ikeda, MD, PhD,
Ichiro Higuchi, MD,
Masayoshi Yasui, MD,
Iwao Seshimo, MD,
Osamu Takayama, MD,
Hirofumi Yamamoto, MD, PhD,
Masayuki Ohue, MD, PhD,
Mitsuaki Tatsumi, MD, PhD,
Jun Hatazawa, MD, PhD,
Masakazu Ikenaga, MD, PhD,
Tsunehiko Nishimura, MD, PhD,
and Morito Monden, MD, PhD
Department of Surgery and Clinical Oncology (E2), Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita,
Kinetics (D9), Osaka 565-0871, Japan
Department of Nuclear Medicine and Tracer Kinetics (D9), Graduate School of Medicine, Osaka University, 2-2 Yamadaoka,
Suita, Osaka 565-0871, Japan
Department of Surgery, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka540-0006, Osaka, Japan
Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii,
Kawaramachi-Hirokoji, Kamigyo, Kyoto 602-8566, Japan
Background: The aim of this study was to evaluate the clinical and therapeutic value of
digital fusion image (FI) of positron emission tomography (PET) using
glucose and computed tomography (CT) in patients who were suspected of having a local
recurrence of rectal cancer.
Methods:: Forty-two patients (32 men and 10 women; mean age, 61.4 years, range, 40–79
years) with a suspicion of local recurrence after curative resection of rectal cancer were pro-
spectively recruited and underwent
F-ﬂuorodeoxy glucose-PET and CT. The FI was
reconstructed with a commercially available digital software program, T-B Fusion. Wilcoxon
signed rank test was used to compare FI with CT alone or PET alone.
Results: FI yielded a correct diagnosis in 39 (93%) of 42 patients, whereas CT alone and
PET alone did so in 33 (79%) and 37 (88%) patients, respectively. FI had better diagnostic
accuracy than CT alone (P = .0138) and PET alone (P = .0156). Overall, FI altered patient
management in 11 (26.2%) patients on the basis of additional information, including differ-
entiation of the tumor from the postoperative scar in 6 patients, exact anatomical location in 3
patients, and both in 2 patients.
Conclusions: FI has a potential clinical value in the treatment of suspected local recurrence
of rectal cancer.
PET—CT—Fusion image—Local recurrence of rectal cancer.
Local recurrence of rectal cancer is still a critical
issue in the management of primary advanced rectal
cancer. It is reported that approximately one third of
rectal cancer patients undergoing curative radical
resection will develop local recurrence.
and survival are possible for patients with isolated
pelvic recurrence after extended radical operations,
such as total pelvic exenteration and adjuvant che-
motherapy. Wanebo et al.
reported that local
recurrence of rectal cancer can be resected safely with
Received August 2, 2004; accepted January 19, 2005; published
Address correspondence and reprint requests to: Mitsugu
Sekimoto, MD, PhD; E-mail: email@example.com.
Published by Springer Science+Business Media, Inc. Ó 2005 The Society of
Surgical Oncology, Inc.
Annals of Surgical Oncology, 12(7): 1)9