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To Enhance or Not to Enhance? The Role of Contrast Medium 18F-FDG PET/CT in Recurrent Ovarian Carcinomas

Department of Nuclear Medicine, E.O. “Ospedali Galliera”, Mura delle Cappuccine 14, 16128 Genoa, Italy
IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Milan, Italy
Department of Medical Physics, E.O. “Ospedali Galliera”, 16128 Genoa, Italy
Department of Oncology, E.O. “Ospedali Galliera”, 16128 Genoa, Italy
Department of Radiology, E.O. “Ospedali Galliera, 16128 Genoa, Italy
Faculty of Biology and Medicine, University of Lausanne, 1100 Lausanne, Switzerland
Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
Faculty of Biomedical Sciences, Università della Svizzera italiana, 6900 Lugano, Switzerland
Author to whom correspondence should be addressed.
Shared first authorship.
Shared senior authorship.
Academic Editors: Domenico Albano and Francesco Bertagna
Medicina 2021, 57(6), 561;
Received: 23 April 2021 / Revised: 29 May 2021 / Accepted: 31 May 2021 / Published: 1 June 2021
(This article belongs to the Special Issue 2-[18F]-FDG PET/CT in Oncology: New Evidences and Future Perspectives)
Background and Objectives: 18F-fluorodeoxyglucose (FDG) positron emission tomography/X-ray computed tomography (PET/CT) represents the mainstay diagnostic procedure for suspected ovarian cancer (OC) recurrence. PET/CT can be integrated with contrast medium and in various diagnostic settings; however, the effective benefit of this procedure is still debated. We aimed to compare the diagnostic capabilities of low-dose and contrast-enhanced PET/CT (PET/ldCT and PET/ceCT) in patients with suspected ovarian cancer relapse. Materials and Methods: 122 OC patients underwent both PET/ldCT and PET/ceCT. Two groups of nuclear medicine physicians and radiologists scored the findings as positive or negative. Clinical/radiological follow-up was used as ground truth. Sensitivity, specificity, negative/positive predictive value, and accuracy were calculated at the patient and the lesion level. Results: A total of 455 and 474 lesions were identified at PET/ldCT and PET/ceCT, respectively. At the lesion level, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were not significantly different between PET/ldCT and PET/ceCT (98%, 93.3%, 97.4%, 94.9%, and 96.9% for PET/ldCT; 99%, 95.5%, 98.3%, 97%, and 98% for PET/ceCT, p = ns). At the patient level, no significant differences in these parameters were identified (e.g., p = 0.22 and p = 0.35 for accuracy, in the peritoneum and lymph nodes, respectively). Smaller peritoneal/lymph node lesions close to physiological FDG uptake sources were found in the cases of misidentification by PET/ldCT. PET/ceCT prompted a change in clinical management in four cases (3.2%) compared to PET/ldCT. Conclusions: PET/ceCT does not perform better than PET/ldCT but can occasionally clarify doubtful peritoneal findings on PET/ldCT. To avoid unnecessary dose to the patient, PET/ceCT should be excluded in selected cases. View Full-Text
Keywords: PET/CT; contrast enhancement; ovarian cancer; FDG; relapse PET/CT; contrast enhancement; ovarian cancer; FDG; relapse
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MDPI and ACS Style

Massollo, M.; Fiz, F.; Bottoni, G.; Ugolini, M.; Paparo, F.; Puppo, C.; Provinciali, N.; Iacozzi, M.; Altrinetti, V.; Cistaro, A.; Cabria, M.; DeCensi, A.; Treglia, G.; Piccardo, A. To Enhance or Not to Enhance? The Role of Contrast Medium 18F-FDG PET/CT in Recurrent Ovarian Carcinomas. Medicina 2021, 57, 561.

AMA Style

Massollo M, Fiz F, Bottoni G, Ugolini M, Paparo F, Puppo C, Provinciali N, Iacozzi M, Altrinetti V, Cistaro A, Cabria M, DeCensi A, Treglia G, Piccardo A. To Enhance or Not to Enhance? The Role of Contrast Medium 18F-FDG PET/CT in Recurrent Ovarian Carcinomas. Medicina. 2021; 57(6):561.

Chicago/Turabian Style

Massollo, Michela, Francesco Fiz, Gianluca Bottoni, Martina Ugolini, Francesco Paparo, Cristina Puppo, Nicoletta Provinciali, Massimiliano Iacozzi, Vania Altrinetti, Angelina Cistaro, Manlio Cabria, Andrea DeCensi, Giorgio Treglia, and Arnoldo Piccardo. 2021. "To Enhance or Not to Enhance? The Role of Contrast Medium 18F-FDG PET/CT in Recurrent Ovarian Carcinomas" Medicina 57, no. 6: 561.

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