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Objective <p>Post-treatment surveillance after locally treated colorectal liver metastases involves CEA measurement and contrast-enhanced CT (CECT) scans. However, reactive tissue around ablated lesions can appear similar to viable tumor tissue on CECT, complicating the detection of local tumor progression (LTP). Therefore, a new imaging protocol was initiated, which incorporates [<sup>18</sup>F]FDG-PET/CT to complement CECT. This study evaluated the diagnostic accuracy of [<sup>18</sup>F]FDG-PET/CECT for early detection of disease progression after resection or thermal ablation, compared to CECT alone.</p> Materials and methods <p>The study analyzed a prospective cohort of patients undergoing thermal ablation or resection, who received CECT and [<sup>18</sup>F]FDG-PET/CT scans 3–5 months post-treatment. Disease progression was confirmed by histology, consensus during a multidisciplinary team meeting or after extended follow-up. Diagnostic accuracy of [<sup>18</sup>F]FDG-PET/CECT was compared to standard practice (CEA serum levels and CECT).</p> Results <p>The final analysis included 64 patients with 154 lesions. 37 patients underwent ablation, 14 patients underwent resection, and 13 patients underwent combination therapy, resulting in 93 (60%) lesions being treated with thermal ablation and 61 (40%) lesions with resection. Disease progression was found in 66% of patients, with LTP detected in 25% of treated lesions. Compared to CECT, [<sup>18</sup>F]FDG-PET/CECT had a higher diagnostic accuracy for detecting local progression after thermal ablation (AUC 0.97 vs. 0.73, <i>p</i> = 0.001) and hepatic resection (AUC 0.96 vs. 0.69, <i>p</i> = 0.03), and for detection of extrahepatic disease (AUC 0.91 vs. 0.79, <i>p</i> = 0.03). CEA serum levels had low diagnostic accuracy for detecting disease progression (AUC 0.60).</p> Conclusion <p>[<sup>18</sup>F]FDG-PET/CECT improves diagnostic accuracy in the early follow-up of patients with locally treated colorectal liver metastases.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis><i>: Interpreting CECT scans after local treatment of colorectal liver metastases can be challenging because reactive tissue around treated lesions can appear similar to viable tumor tissue</i>.</p> <p><Emphasis Type="BoldItalic">Findings</Emphasis><i>: [</i><sup><i>18</i></sup><i>F]FDG-PET/CECT improves the diagnostic accuracy of detecting local tumor progression after thermal ablation and resection of colorectal liver metastases</i>.</p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis><i>: [</i><sup><i>18</i></sup><i>F]FDG-PET/CECT should be considered during follow-up after local treatment of colorectal liver metastases to identify and treat local tumor progression earlier</i>.</p> Graphical Abstract <p></p>

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Improved detection of local tumor progression after ablation or resection of colorectal liver metastases using [18F]FDG-PET/contrast-enhanced CT versus contrast-enhanced CT alone: results from a Dutch prospective cohort

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月11日

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  • O. D. Bijlstra,
  • S. van Mossel,
  • B. Boekestijn,
  • M. C. Burgmans,
  • E. L. van Persijn van Meerten,
  • D. D. D. Rietbergen,
  • S. Shahbazi Feshtali,
  • R. J. Swijnenburg,
  • F. H. P. van Velden,
  • H. Koffijberg,
  • L. F. de Geus-Oei,
  • J. S. D. Mieog

摘要

Objective

Post-treatment surveillance after locally treated colorectal liver metastases involves CEA measurement and contrast-enhanced CT (CECT) scans. However, reactive tissue around ablated lesions can appear similar to viable tumor tissue on CECT, complicating the detection of local tumor progression (LTP). Therefore, a new imaging protocol was initiated, which incorporates [18F]FDG-PET/CT to complement CECT. This study evaluated the diagnostic accuracy of [18F]FDG-PET/CECT for early detection of disease progression after resection or thermal ablation, compared to CECT alone.

Materials and methods

The study analyzed a prospective cohort of patients undergoing thermal ablation or resection, who received CECT and [18F]FDG-PET/CT scans 3–5 months post-treatment. Disease progression was confirmed by histology, consensus during a multidisciplinary team meeting or after extended follow-up. Diagnostic accuracy of [18F]FDG-PET/CECT was compared to standard practice (CEA serum levels and CECT).

Results

The final analysis included 64 patients with 154 lesions. 37 patients underwent ablation, 14 patients underwent resection, and 13 patients underwent combination therapy, resulting in 93 (60%) lesions being treated with thermal ablation and 61 (40%) lesions with resection. Disease progression was found in 66% of patients, with LTP detected in 25% of treated lesions. Compared to CECT, [18F]FDG-PET/CECT had a higher diagnostic accuracy for detecting local progression after thermal ablation (AUC 0.97 vs. 0.73, p = 0.001) and hepatic resection (AUC 0.96 vs. 0.69, p = 0.03), and for detection of extrahepatic disease (AUC 0.91 vs. 0.79, p = 0.03). CEA serum levels had low diagnostic accuracy for detecting disease progression (AUC 0.60).

Conclusion

[18F]FDG-PET/CECT improves diagnostic accuracy in the early follow-up of patients with locally treated colorectal liver metastases.

Key Points

Question: Interpreting CECT scans after local treatment of colorectal liver metastases can be challenging because reactive tissue around treated lesions can appear similar to viable tumor tissue.

Findings: [18F]FDG-PET/CECT improves the diagnostic accuracy of detecting local tumor progression after thermal ablation and resection of colorectal liver metastases.

Clinical relevance: [18F]FDG-PET/CECT should be considered during follow-up after local treatment of colorectal liver metastases to identify and treat local tumor progression earlier.

Graphical Abstract