الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The aim of this study was to evaluate the diagnostic impact of integrated positron emission and computed tomography (PET/CT) in patients with malignant biliary obstruction and to study whether the metabolic information provided by a prior PET/computed tomography (CT) scan could add valuable information and an incremental benefit while performing image-guided biopsies.
Fifty two patients with suspected/diagnosed to have malignant biliary obstruction were included in this study. The median age was 60 yrs. (range 20–83 yrs.) with a gender distribution of 36 men (69.2%) and 16 women (30.8%).
All examined cases in our study were subjected to the following: history taking, radiological investigations included: PET CT, previous CT (42 cases), previous MRCP (15 cases), biopsy examination for (30) cases and PETCT biopsy for (15) cases.
According to our study we found that
Sensitivity, specificity, PPV and NPV for PETCT for primary detection of malignant biliary obstruction lesions were 92%, 75%, 96% and 60% respectively while for CT and MRCP 68%, 60%, 85%, 20 % and 60% 50%, 85 %, 20% respectively. PET CT had sensitivity of 90% for detection of lymph nodal Mets compared to 37 % for CT and 20% for MRCP.PET CT was more accurate than CTand MRI for M staging except for liver deposits MRI is superior. PET CT have changed management in 20/52 patients (38.5 %).
Diagnostic biopsies providing a representative sample and a definitive diagnosis using PET CT co-registration with intraprocedural CT were technically successful in 100% of patients (15/15)
from this study we concluded that
1-PET/CT was useful in the evaluation of patients with suspected primary or recurrent malignant biliary obstruction neoplasms.
2-PET/CT was more sensitive and specific than CT and MRI in the detection of small primary tumors and infiltrating type cholangio-carcinomas and gallbladder carcinoma also
3-PET/CT was superior to CT and MRI in the clarification of lymph nodal and distant metastases.
4-PET/CT was benefical in assessing response to neo-adjuvant chemoradiation.
5-The application of 18FDG-PET in addition to CT may alter clinical management in a significant fraction of patients with malignanat biliary obstruction.
6- PET/CT was valuable for evaluating patients with malignant biliary neoplasms after surgery and can differentiate possible diseases recurrence/residual lesions from post-operative changes.
7-The application of PET/CT findings to image-guided biopsy can contribute to early histologic diagnosis and staging of malignancy.
8- PET/CT findings can potentially help improve the diagnostic accuracy of image-guided biopsy by indicating metabolically active regions within areas of necrosis, fibrosis and post operative or irradiation changes. PET/CT findings are useful in selecting the most accessible lesion to biopsy among multiple metabolically active lesions. PET/CT findings can guide an operator to a lesion targeted for biopsy with few or no morphologic changes observed at anatomic imaging.