FDG-PET/CT in colorectal cancer: potential for vascular-metabolic imaging to provide markers of prognosis

Shih hsin Chen, Kenneth Miles, Stuart A. Taylor, Balaji Ganeshan, Manuel Rodriquez, Francesco Fraioli, Simon Wan, Asim Afaq, Robert Shortman, Darren Walls, Luke Hoy, Raymond Endozo, Aman Bhargava, Matthew Hanson, Joseph Huang, Sherif Raouf, Daren Francis, Shahab Siddiqi, Tan Arulampalam, Bruce SizerMichael Machesney, Nicholas Reay-Jones, Sanjay Dindyal, Tony Ng, Ashley Groves*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Purpose: This study assesses the potential for vascular-metabolic imaging with FluoroDeoxyGlucose (FDG)–Positron Emission Tomography/Computed Tomography (PET/CT) perfusion to provide markers of prognosis specific to the site and stage of colorectal cancer. Methods: This prospective observational study comprised of participants with suspected colorectal cancer categorized as either (a) non-metastatic colon cancer (M0colon), (b) non-metastatic rectal cancer (M0rectum), or (c) metastatic colorectal cancer (M+). Combined FDG-PET/CT perfusion imaging was successfully performed in 286 participants (184 males, 102 females, age: 69.60 ± 10 years) deriving vascular and metabolic imaging parameters. Vascular and metabolic imaging parameters alone and in combination were investigated with respect to overall survival. Results: A vascular-metabolic signature that was significantly associated with poorer survival was identified for each patient group: M0colon – high Total Lesion Glycolysis (TLG) with increased Permeability Surface Area Product/Blood Flow (PS/BF), Hazard Ratio (HR) 3.472 (95% CI: 1.441–8.333), p = 0.006; M0rectum – high Metabolic Tumour Volume (MTV) with increased PS/BF, HR 4.567 (95% CI: 1.901–10.970), p = 0.001; M+ participants, high MTV with longer Time To Peak (TTP) enhancement, HR 2.421 (95% CI: 1.162–5.045), p = 0.018. In participants with stage 2 colon cancer as well as those with stage 3 rectal cancer, the vascular-metabolic signature could stratify the prognosis of these participants. Conclusion: Vascular and metabolic imaging using FDG-PET/CT can be used to synergise prognostic markers. The hazard ratios suggest that the technique may have clinical utility.

Original languageEnglish
Pages (from-to)371-384
Number of pages14
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Issue number1
Early online date10 Apr 2021
Publication statusPublished - Dec 2021


  • Colorectal cancer
  • CT perfusion
  • Metabolism
  • Survival
  • Vascular


Dive into the research topics of 'FDG-PET/CT in colorectal cancer: potential for vascular-metabolic imaging to provide markers of prognosis'. Together they form a unique fingerprint.

Cite this