Improved detection of local tumor progression after ablation or resection of colorectal liver metastases using [18F]FDG-PET/contrast-enhanced CT versus contrast-enhanced CT alone: Results from a Dutch prospective cohort

O.D. Bijlstra; S. van Mossel; B. Boekestijn; M.C. Burgmans; E.L. van Persijn van Meerten; D.D.D. Rietbergen; S. Shahbazi Feshtali; R.J. Swijnenburg; F.H.P. van Velden; H. Koffijberg; L.F. de Geus-Oei; J.S.D. Mieog

doi:10.1007/s00330-026-12726-x

Improved detection of local tumor progression after ablation or resection of colorectal liver metastases using [¹⁸F]FDG-PET/contrast-enhanced CT versus contrast-enhanced CT alone: Results from a Dutch prospective cohort

O.D. Bijlstra^*
, S. van Mossel
, B. Boekestijn
, M.C. Burgmans
, E.L. van Persijn van Meerten
, D.D.D. Rietbergen
, S. Shahbazi Feshtali
, R.J. Swijnenburg
, F.H.P. van Velden
, H. Koffijberg
, L.F. de Geus-Oei
, J.S.D. Mieog

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Objective: Post-treatment surveillance after locally treated colorectal liver metastases involves CEA measurement and contrast-enhanced CT (CECT) scans. However, reactive tissue around ablated lesions can appear similar to viable tumor tissue on CECT, complicating the detection of local tumor progression (LTP). Therefore, a new imaging protocol was initiated, which incorporates [¹⁸F]FDG-PET/CT to complement CECT. This study evaluated the diagnostic accuracy of [¹⁸F]FDG-PET/CECT for early detection of disease progression after resection or thermal ablation, compared to CECT alone.

Materials and methods: The study analyzed a prospective cohort of patients undergoing thermal ablation or resection, who received CECT and [¹⁸F]FDG-PET/CT scans 3–5 months post-treatment. Disease progression was confirmed by histology, consensus during a multidisciplinary team meeting or after extended follow-up. Diagnostic accuracy of [¹⁸F]FDG-PET/CECT was compared to standard practice (CEA serum levels and CECT).

Results: The final analysis included 64 patients with 154 lesions. 37 patients underwent ablation, 14 patients underwent resection, and 13 patients underwent combination therapy, resulting in 93 (60%) lesions being treated with thermal ablation and 61 (40%) lesions with resection. Disease progression was found in 66% of patients, with LTP detected in 25% of treated lesions. Compared to CECT, [¹⁸F]FDG-PET/CECT had a higher diagnostic accuracy for detecting local progression after thermal ablation (AUC 0.97 vs. 0.73, p = 0.001) and hepatic resection (AUC 0.96 vs. 0.69, p = 0.03), and for detection of extrahepatic disease (AUC 0.91 vs. 0.79, p = 0.03). CEA serum levels had low diagnostic accuracy for detecting disease progression (AUC 0.60).

Conclusion: [¹⁸F]FDG-PET/CECT improves diagnostic accuracy in the early follow-up of patients with locally treated colorectal liver metastases.

Original language	English
Number of pages	9
Journal	European radiology
Early online date	11 Jul 2026
DOIs	https://doi.org/10.1007/s00330-026-12726-x
Publication status	E-pub ahead of print/First online - 11 Jul 2026

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Ablation
Colorectal liver metastases
Follow-up
Local treatment
[F]FDG

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Bijlstra, O. D., van Mossel, S., Boekestijn, B., Burgmans, M. C., van Persijn van Meerten, E. L., Rietbergen, D. D. D., Shahbazi Feshtali, S., Swijnenburg, R. J., van Velden, F. H. P., Koffijberg, H., de Geus-Oei, L. F., & Mieog, J. S. D. (2026). Improved detection of local tumor progression after ablation or resection of colorectal liver metastases using [¹⁸F]FDG-PET/contrast-enhanced CT versus contrast-enhanced CT alone: Results from a Dutch prospective cohort. European radiology. Advance online publication. https://doi.org/10.1007/s00330-026-12726-x

@article{4b7debbf65e144f6b5a792d819edf5a8,

title = "Improved detection of local tumor progression after ablation or resection of colorectal liver metastases using [18F]FDG-PET/contrast-enhanced CT versus contrast-enhanced CT alone: Results from a Dutch prospective cohort",

abstract = "Objective: Post-treatment surveillance after locally treated colorectal liver metastases involves CEA measurement and contrast-enhanced CT (CECT) scans. However, reactive tissue around ablated lesions can appear similar to viable tumor tissue on CECT, complicating the detection of local tumor progression (LTP). Therefore, a new imaging protocol was initiated, which incorporates [18F]FDG-PET/CT to complement CECT. This study evaluated the diagnostic accuracy of [18F]FDG-PET/CECT for early detection of disease progression after resection or thermal ablation, compared to CECT alone.Materials and methods: The study analyzed a prospective cohort of patients undergoing thermal ablation or resection, who received CECT and [18F]FDG-PET/CT scans 3{\textendash}5 months post-treatment. Disease progression was confirmed by histology, consensus during a multidisciplinary team meeting or after extended follow-up. Diagnostic accuracy of [18F]FDG-PET/CECT was compared to standard practice (CEA serum levels and CECT).Results: The final analysis included 64 patients with 154 lesions. 37 patients underwent ablation, 14 patients underwent resection, and 13 patients underwent combination therapy, resulting in 93 (60\%) lesions being treated with thermal ablation and 61 (40\%) lesions with resection. Disease progression was found in 66\% of patients, with LTP detected in 25\% of treated lesions. Compared to CECT, [18F]FDG-PET/CECT had a higher diagnostic accuracy for detecting local progression after thermal ablation (AUC 0.97 vs. 0.73, p = 0.001) and hepatic resection (AUC 0.96 vs. 0.69, p = 0.03), and for detection of extrahepatic disease (AUC 0.91 vs. 0.79, p = 0.03). CEA serum levels had low diagnostic accuracy for detecting disease progression (AUC 0.60).Conclusion: [18F]FDG-PET/CECT improves diagnostic accuracy in the early follow-up of patients with locally treated colorectal liver metastases.",

keywords = "Ablation, Colorectal liver metastases, Follow-up, Local treatment, [F]FDG",

author = "O.D. Bijlstra and \{van Mossel\}, S. and B. Boekestijn and M.C. Burgmans and \{van Persijn van Meerten\}, E.L. and D.D.D. Rietbergen and \{Shahbazi Feshtali\}, S. and R.J. Swijnenburg and \{van Velden\}, F.H.P. and H. Koffijberg and \{de Geus-Oei\}, L.F. and J.S.D. Mieog",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2026.",

year = "2026",

month = jul,

day = "11",

doi = "10.1007/s00330-026-12726-x",

language = "English",

journal = "European radiology",

issn = "0938-7994",

publisher = "Springer",

}

Bijlstra, OD, van Mossel, S, Boekestijn, B, Burgmans, MC, van Persijn van Meerten, EL, Rietbergen, DDD, Shahbazi Feshtali, S, Swijnenburg, RJ, van Velden, FHP, Koffijberg, H , de Geus-Oei, LF & Mieog, JSD 2026, 'Improved detection of local tumor progression after ablation or resection of colorectal liver metastases using [¹⁸F]FDG-PET/contrast-enhanced CT versus contrast-enhanced CT alone: Results from a Dutch prospective cohort', European radiology. https://doi.org/10.1007/s00330-026-12726-x

Improved detection of local tumor progression after ablation or resection of colorectal liver metastases using [¹⁸F]FDG-PET/contrast-enhanced CT versus contrast-enhanced CT alone: Results from a Dutch prospective cohort. / Bijlstra, O.D.; van Mossel, S.; Boekestijn, B. et al.
In: European radiology, 11.07.2026.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Improved detection of local tumor progression after ablation or resection of colorectal liver metastases using [18F]FDG-PET/contrast-enhanced CT versus contrast-enhanced CT alone

T2 - Results from a Dutch prospective cohort

AU - Bijlstra, O.D.

AU - van Mossel, S.

AU - Boekestijn, B.

AU - Burgmans, M.C.

AU - van Persijn van Meerten, E.L.

AU - Rietbergen, D.D.D.

AU - Shahbazi Feshtali, S.

AU - Swijnenburg, R.J.

AU - van Velden, F.H.P.

AU - Koffijberg, H.

AU - de Geus-Oei, L.F.

AU - Mieog, J.S.D.

PY - 2026/7/11

Y1 - 2026/7/11

N2 - Objective: Post-treatment surveillance after locally treated colorectal liver metastases involves CEA measurement and contrast-enhanced CT (CECT) scans. However, reactive tissue around ablated lesions can appear similar to viable tumor tissue on CECT, complicating the detection of local tumor progression (LTP). Therefore, a new imaging protocol was initiated, which incorporates [18F]FDG-PET/CT to complement CECT. This study evaluated the diagnostic accuracy of [18F]FDG-PET/CECT for early detection of disease progression after resection or thermal ablation, compared to CECT alone.Materials and methods: The study analyzed a prospective cohort of patients undergoing thermal ablation or resection, who received CECT and [18F]FDG-PET/CT scans 3–5 months post-treatment. Disease progression was confirmed by histology, consensus during a multidisciplinary team meeting or after extended follow-up. Diagnostic accuracy of [18F]FDG-PET/CECT was compared to standard practice (CEA serum levels and CECT).Results: The final analysis included 64 patients with 154 lesions. 37 patients underwent ablation, 14 patients underwent resection, and 13 patients underwent combination therapy, resulting in 93 (60%) lesions being treated with thermal ablation and 61 (40%) lesions with resection. Disease progression was found in 66% of patients, with LTP detected in 25% of treated lesions. Compared to CECT, [18F]FDG-PET/CECT had a higher diagnostic accuracy for detecting local progression after thermal ablation (AUC 0.97 vs. 0.73, p = 0.001) and hepatic resection (AUC 0.96 vs. 0.69, p = 0.03), and for detection of extrahepatic disease (AUC 0.91 vs. 0.79, p = 0.03). CEA serum levels had low diagnostic accuracy for detecting disease progression (AUC 0.60).Conclusion: [18F]FDG-PET/CECT improves diagnostic accuracy in the early follow-up of patients with locally treated colorectal liver metastases.

AB - Objective: Post-treatment surveillance after locally treated colorectal liver metastases involves CEA measurement and contrast-enhanced CT (CECT) scans. However, reactive tissue around ablated lesions can appear similar to viable tumor tissue on CECT, complicating the detection of local tumor progression (LTP). Therefore, a new imaging protocol was initiated, which incorporates [18F]FDG-PET/CT to complement CECT. This study evaluated the diagnostic accuracy of [18F]FDG-PET/CECT for early detection of disease progression after resection or thermal ablation, compared to CECT alone.Materials and methods: The study analyzed a prospective cohort of patients undergoing thermal ablation or resection, who received CECT and [18F]FDG-PET/CT scans 3–5 months post-treatment. Disease progression was confirmed by histology, consensus during a multidisciplinary team meeting or after extended follow-up. Diagnostic accuracy of [18F]FDG-PET/CECT was compared to standard practice (CEA serum levels and CECT).Results: The final analysis included 64 patients with 154 lesions. 37 patients underwent ablation, 14 patients underwent resection, and 13 patients underwent combination therapy, resulting in 93 (60%) lesions being treated with thermal ablation and 61 (40%) lesions with resection. Disease progression was found in 66% of patients, with LTP detected in 25% of treated lesions. Compared to CECT, [18F]FDG-PET/CECT had a higher diagnostic accuracy for detecting local progression after thermal ablation (AUC 0.97 vs. 0.73, p = 0.001) and hepatic resection (AUC 0.96 vs. 0.69, p = 0.03), and for detection of extrahepatic disease (AUC 0.91 vs. 0.79, p = 0.03). CEA serum levels had low diagnostic accuracy for detecting disease progression (AUC 0.60).Conclusion: [18F]FDG-PET/CECT improves diagnostic accuracy in the early follow-up of patients with locally treated colorectal liver metastases.

KW - Ablation

KW - Colorectal liver metastases

KW - Follow-up

KW - Local treatment

KW - [F]FDG

UR - https://www.scopus.com/pages/publications/105044456205

U2 - 10.1007/s00330-026-12726-x

DO - 10.1007/s00330-026-12726-x

M3 - Article

AN - SCOPUS:105044456205

SN - 0938-7994

JO - European radiology

JF - European radiology

ER -

Bijlstra OD, van Mossel S, Boekestijn B, Burgmans MC, van Persijn van Meerten EL, Rietbergen DDD et al. Improved detection of local tumor progression after ablation or resection of colorectal liver metastases using [¹⁸F]FDG-PET/contrast-enhanced CT versus contrast-enhanced CT alone: Results from a Dutch prospective cohort. European radiology. 2026 Jul 11. Epub 2026 Jul 11. doi: 10.1007/s00330-026-12726-x