Imaging features of primary and recurrent esophageal cancer at FDG PET

Because of the poor prognosis for patients with esophageal Cancer and the r isks associated with surgical intervention, accurate staging is essential f or optimal treatment planning. Positron emission tomography (PET) with 2-[f luorine-18] fluoro-2-deoxy-D-glucose (FDG) is a useful adjunct to more conv entional imaging modalities in this setting. FDG PET is not an appropriate first-line diagnostic procedure in the detection of esophageal cancer and i s not helpful in detecting local invasion by the primary tumor, and further studies are required to determine its efficacy in the detection of local n odal metastases. However, FDG PET is superior to anatomic imaging modalitie s in the ability to detect distant metastases. Metastases to the liver, lun gs, and skeleton can readily be identified at FDG PET. In addition, FDG PET has proved valuable in determining the resectability of disease and allows scanning of a larger volume than is possible with computed tomography. Rec urrent disease is readily diagnosed and differentiated from scar tissue wit h FDG PET. In addition, FDG PET may play a valuable role in the follow-up o f patients who undergo chemotherapy and radiation therapy, allowing early c hanges in treatment for unresponsive tumors. The management of most patient s with esophageal cancer can be improved with use of FDG PET.