FDG-PET is able to detect pancreatic carcinoma in chronic pancreatitis

M. van Kouwen, J. Jansen, H. van Goor, S. de Castro, W. Oyen and J. Drenth

Department of Gastroenterology, University Medical Center, St. Radboud, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. m.vankouwen@mdl.umcn.nl
Apr, 2005



2-(18F)-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) is an imaging technique which enables detection of malignancies. FDG-PET has been established as a tool for the diagnosis of pancreatic carcinoma (CA). Early detection is mandatory as cure can only be achieved in non-advanced disease. This is, however, very difficult with conventional radiological techniques. Patients with chronic pancreatitis (CP) are at risk of developing CA. A simple, reliable screening method for malignant degeneration is highly desirable. We set out to investigate whether FDG-PET is able to detect CA in the setting of CP and can fulfil a potential role in the early detection of CA in CP.FDG-PET was performed in 77 CP patients and in six patients with CP complicated by CA (CP + CA). We included 26 CA patients as a positive control. A positive scan was defined as focal FDG accumulation in the pancreas region.In 67 of the 77 CP (87\%) patients, pancreatic FDG accumulation was absent. Six patients had significant accumulation. In CA, 24/26 patients had a positive PET. Five out of the six patients with CP + CA had focal uptake, while minor uptake was seen in one patient. FDG-PET was positive in almost all CA patients and CP + CA patients. FDG-PET was negative in the large majority (87\%) of CP patients, which suggests that a positive PET scan in CP patients must lead to efforts to exclude a malignancy.These data suggest that FDG-PET has a potential role as a diagnostic tool for detecting CA in longstanding CP.