Fusion Image of Positron Emission Tomography and
Computed Tomography for the Diagnosis of Local
Recurrence of Rectal Cancer
Hiroki Fukunaga, MD,
1
Mitsugu Sekimoto, MD, PhD,
1
Masataka Ikeda, MD, PhD,
1
Ichiro Higuchi, MD,
1
Masayoshi Yasui, MD,
1
Iwao Seshimo, MD,
1
Osamu Takayama, MD,
1
Hirofumi Yamamoto, MD, PhD,
1
Masayuki Ohue, MD, PhD,
1
Mitsuaki Tatsumi, MD, PhD,
2
Jun Hatazawa, MD, PhD,
2
Masakazu Ikenaga, MD, PhD,
3
Tsunehiko Nishimura, MD, PhD,
4
and Morito Monden, MD, PhD
1
1
Department of Surgery and Clinical Oncology (E2), Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita,
Kinetics (D9), Osaka 565-0871, Japan
2
Department of Nuclear Medicine and Tracer Kinetics (D9), Graduate School of Medicine, Osaka University, 2-2 Yamadaoka,
Suita, Osaka 565-0871, Japan
3
Department of Surgery, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka540-0006, Osaka, Japan
4
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
18
F-fluorodeoxy
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
18
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.
Key Words:
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.
1
Local control
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.
2
reported that local
recurrence of rectal cancer can be resected safely with
Received August 2, 2004; accepted January 19, 2005; published
online j.
Address correspondence and reprint requests to: Mitsugu
Sekimoto, MD, PhD; E-mail: sekimoto@surg2.med.osaka-u.ac.jp.
Published by Springer Science+Business Media, Inc. Ó 2005 The Society of
Surgical Oncology, Inc.
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Annals of Surgical Oncology, 12(7): 1)9
DOI: 10.1245/ASO.2005.08.001
1