Figure 7. Transaxial and saggital sections of an 18F-FDG image showing normal bladder activity anteriorly and recurrent rectal carcinoma posteriorly (arrow). (Courtesy of ADAC Labs and Dr. J.F. Gaillard, HIA Val de Grace, Paris, France.)

with CT sensitivity of 65-75%; FDG specificity is also high. FDG imaging alters the management of colorectal cancer in about 30% of patients. Some data suggest that FDG imaging might monitor response to therapy. A fall in FDG uptake after 1 cycle of chemotherapy appears to predict a good response whilst no change or an increase in uptake suggests treatment failure and progression.

MAbs have also been reported as being effective in evaluating patients with colorectal cancer. Mabs such as arcitumomab (CEAscan®) and satumomab pendetide (OncoScint®) may either be used in conjunction with an intraoperative gamma probe or by conventional imaging techniques. Arcitumomab (CEAscan®) has been demonstrated to increase the clinical accuracy of CT when used in conjunction with CT: it improved the correct prediction of resectability by 40% and the correct prediction of unresectability by 100% when compared with CT alone. Using the same MAb, radioimmunoguided surgery has been shown to increase the number of tumor sites in a locoregional distribution; although long term follow-up has not been reported, the study argues for the inclusion of radioimmunoguided surgery in the management of patients with locoregional extension.

MAb imaging is technically more difficult than many nuclear medicine procedures and there is a steep learning curve to image interpretation; routine imaging with MAbs should only be performed in departments with experience in the technique and training courses are available for the use of radioimmunoguided surgery. If available, 18F-FDG imaging is probably a more sensitive and routinely interpretable investigation.

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