F-18 Fluorodeoxyglucose (FDG) and C-Reactive Protein (CRP)

This study was done to evaluate if the accuracy of FDG-PET concerning the differentiation of benign and malignant pancreatic masses differs for patients with and without elevated C-Reactive Protein (CRP). Three hundred-four patients (165 neoplasms, 98 chronic pancreatitis, and 41 benign lesions) received FDG-PET of the abdomen prior to planned resective surgery. CRP was unknown, normal, and elevated with 211, 71, and 22 patients, respectively. For differentiation of benign and malignant lesions, specificity was 87% for patients with unknown or normal CRP, and it was 40% for patients with elevated CRP (P < 0.01). Thirty-five percent of those patients with both a positive PET and elevated CRP were false positive. On the contrary, sensitivity was slightly higher in the group with elevated CRP (92% vs. 80%, NS). FDG-PET is a sensitive and specific test for patients with normal CRP, however, FDG-PET may be false positive if CRP is elevated. Proper patient selection is therefore important. CRP or other parameters indicative of active inflammation appear useful adjuncts for the interpretation of increased FDG-accumulation.