Significance of incidental 18F-FDG accumulations in the gastrointestinal tract in PET/CT: correlation with endoscopic and histopathologic results
Ehab M Kamel, Miriam Thumshirn, Kaspar Truninger, Marc Schiesser, Michael Fried, Barbara Padberg, Didier Schneiter, Sandro Stöckli, Gustav K Von Schulthess & Katrin D M Stumpe
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abstract
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This study was undertaken to identify the clinical value of
incidentally detected lesions (IDLs) in the gastrointestinal tract
(GIT) with (18)F-FDG PET/CT. METHODS: The reported database of 3,281
patients who underwent partial-body (18)F-FDG PET/CT scans from
April 2001 to September 2003 was reviewed. Patients with incidental
(18)F-FDG accumulations in the GIT that were associated with
concomitant abnormal soft-tissue density or wall thickening on the
native CT were evaluated. Incidental PET/CT findings were correlated
with endoscopic and histopathologic results. RESULTS: According to
our selection criteria, 98 (3%) of the 3,281 patients had an IDL of
the GIT on (18)F-FDG PET/CT. Correlative endoscopic findings were
available in 69 (70%) of 98 patients. Of these, 13 patients (19%)
were harboring newly occurring cancers of the GIT in addition to
preexisting aerodigestive tract tumors (n = 12) and malignant
melanoma (n = 1). Twenty-nine (42%) patients were identified with
precancerous lesions, such as advanced colonic adenomas (n = 27),
Barrett's esophagus (n = 1), and intestinal metaplasia of the
gastric mucosa (n = 1). Inflammatory and other benign GIT lesions
were detected in 12 (17%) and 6 (8%) patients, respectively. In 9
(13%) patients, PET/CT was false-positive, showing normal findings
in subsequent endoscopic examinations. In 20 (28%) of 69 patients,
PET/CT findings had a relevant impact on the clinical management.
Twenty-nine (30%) of the 98 patients were not subject to a further
endoscopic examination because of the extent and nature of the
primary tumor (n = 17), loss to follow-up (n = 7), death shortly
after PET (n = 3), and patient unwillingness (n = 2). CONCLUSION:
Although IDLs of the GIT on (18)F-FDG PET/CT scans are found only in
about 3% of cases, they are associated with a substantial risk of an
underlying cancerous or precancerous lesion. Early identification of
these occult lesions may have a major impact on the patients'
management and outcome.
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citation
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Kamel E M, Thumshirn M, Truninger K, Schiesser M, Fried M, Padberg
B, Schneiter D, Stöckli S, Von Schulthess G K, Stumpe K D M.
Significance of incidental 18F-FDG accumulations in the
gastrointestinal tract in PET/CT: correlation with endoscopic and
histopathologic results. Journal of nuclear medicine : official
publication, Society of Nuclear Medicine 2004; 45:1804-10.
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type
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journal paper/review (English)
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date of publishing
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11-2004
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journal title
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Journal of nuclear medicine : official publication, Society of
Nuclear Medicine (45/11)
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ISSN print
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0161-5505
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pages
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1804-10
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PubMed
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15534047
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