Integrated PET-CT Imaging: Implications for Evaluation of Patients with Colorectal Carcinoma

The evaluation of patients with known or suspected recurrent colorectal carcinoma is now an accepted indication for positron emission tomography using 18F-fluorodeoxyglucose (FDG-PET) imaging. PET and CT are complimentary and therefore, integrated PET/CT imaging should be performed where available. FDG-PET/CT is indicated as the initial test for diagnosis and staging of recurrence and for preoperative staging (N and M) of known recurrence that is considered to be resectable. FDG-PET imaging is valuable for the differentiation of post-treatment changes from recurrent tumor, differentiation of benign from malignant lesions (indeterminate lymph nodes, hepatic and pulmonary lesions), and the evaluation of patients with rising tumor markers in the absence of a known source. The addition of FDG-PET/CT to the evaluation of these patients reduces overall treatment costs by accurately identifying patients who will and will not benefit from surgical procedures. This new powerful technology provides more accurate interpretation of both CT and FDG-PET images and therefore more optimal patient care. PET/CT fusion images affect the clinical management by guiding further procedures (biopsy, surgery, radiation therapy), excluding the need for additional procedures, and changing both inter- and intramodality therapy.