Selection of patients for resection of hepatic metastases: Improved detection of extrahepatic disease with FDG PET

A rapidly emerging clinical application of positron emission tomography (PE T) is the detection of tumor tissue at whole-body studies performed with th e glucose analogue 2- [fluorine- 18] fluoro-2-deoxy-D-glucose (FDG). High r ates of recurrence after partial hepatic resection in patients with colorec tal cancer liver metastases indicate that current presurgical imaging strat egies are failing to show extrahepatic tumor deposits. Although FDG PET can not match the anatomic resolution of conventional imaging techniques in the liver and the lungs, it is particularly useful for identification and char acterization of extrahepatic disease. FDG PET can show foci of metastatic d isease that may not be apparent at conventional anatomic imaging and can ai d in the characterization of indeterminate soft-tissue masses. Several sour ces of benign and physiologic increased activity at FDG PET emphasize the n eed for careful correlation with findings of other imaging studies and clin ical findings. FDG PET can improve the selection of patients for partial he patic resection and thereby reduce the morbidity and mortality associated w ith inappropriate surgery.