Comparison of FDG-PET, PET/CT and MRI for follow-up of colorectal liver metastases treated with radiofrequency ablation: Initial results

Purpose: Morphologic imaging after radiofrequency ablation (RFA) of liver metastases is hampered by rim-like enhancement in the ablation margin, making the identification of local tumor progression (LTP) difficult. Follow-up with PET/CT is compared to follow-up with PET alone and MRI after RFA. Methods and materials: Sixteen patients showed 25 FDG-positive colorectal liver metastases in pre-interventional PET/CT. Post-interventional PET/CT was performed 24 h after ablation and was repeated after 1, 3 and 6 months and then every 6 months. PET and PET/CT data were compared with MR data sets acquired within 14 days before or after these time points. Either histological proof by biopsy or resection, or a combination of contrast-enhanced CT at fixed time points and clinical data served as a reference. Results: The 25 metastases showed a mean size of 20 mm and were treated with 39 RFA sessions. Ten lesions which developed LTP received a second round of RFA; four lesions received three rounds of treatment. The mean follow-up time was 22 months. Seventy-two PET/CT and 57 MR examinations were performed for follow-up. The accuracy and sensitivity for tumor detection was 86% and 76% for PET alone, 91% and 83% for PET/CT and 92% and 75% for MRI, respectively. Conclusions: In comparison to PET alone, PET/CT was significantly better for detecting LTP after RFA. There were no significant differences between MRI and PET/CT. These preliminary results, however, need further verification.