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Incidental 18F-FDG uptake in the colon: value of contrast-enhanced CT correlation with colonoscopic findings

  • Julian KirchnerEmail author
  • Benedikt M. Schaarschmidt
  • Firas Kour
  • Lino M. Sawicki
  • Ole Martin
  • Johannes Bode
  • Stephan vom Dahl
  • Verena Keitel
  • Dieter Häussinger
  • Christina Antke
  • Christian Buchbender
  • Gerald Antoch
  • Philipp Heusch
Original Article
  • 14 Downloads
Part of the following topical collections:
  1. Oncology – Digestive tract

Abstract

Objectives

To evaluate the impact of morphological information derived from contrast-enhanced CT in the characterization of incidental focal colonic uptake in 18F-FDG PET/CT examinations.

Methods

A total of 125 patients (female: n = 53, male: n = 72) that underwent colonoscopy secondary to contrast-enhanced, full-dose PET/CT without special bowel preparation were included in this retrospective study. PET/CT examinations were assessed for focal colonic tracer uptake in comparison with the background. Focal tracer uptake was correlated with morphological changes of the colonic wall in the contrast-enhanced CT images. Colonoscopy reports were evaluated for benign, inflammatory, polypoid, precancerous, and cancerous lesions verified by histopathology, serving as a reference standard. Sensitivity, specificity, PPV, NPV, and accuracy for detection of therapeutic relevant findings were calculated for (a) sole focal tracer uptake and (b) focal tracer uptake with correlating CT findings in contrast-enhanced CT.

Results

In 38.4% (48/125) of the patients, a focal 18F-FDG uptake was observed within 67 lesions. Malignant lesions were endoscopically and histopathologically diagnosed in eleven patients, and nine of these were detected by focal 18F-FDG uptake. A total of 34 lesions with impact on short- or long-term patient management (either being pre- or malignant) were detected. Sensitivity, Specificity, PPV, NPV, and accuracy for sole 18F-FDG uptake for this combined group were 54%, 69%, 29%, 85%, and 65%. Corresponding results for focal 18F-FDG uptake with correlating CT findings were 38%, 90%, 50%, 86%, and 80%. This resulted in a statistically significant difference for diagnostic accuracy (p = 0.0001)

Conclusion

By analyzing additional morphological changes in contrast-enhanced CT imaging, the specificity of focal colonic 18F-FDG uptake for precancerous and cancerous lesions can be increased but leads to a considerate loss of sensitivity. Therefore, every focal colonic uptake should be followed up by colonoscopy.

Keywords

18F-FDG Colon Contrast-enhanced CT 

Notes

Acknowledgments

This publication contains parts of the MD thesis of Firas Kour and is therefore in partial fulfillment of the requirements for an MD thesis at the Medical Faculty of the Heinrich-Heine University, Düsseldorf.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was waived by the IRB for this retrospective analysis.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Julian Kirchner
    • 1
    Email author
  • Benedikt M. Schaarschmidt
    • 1
  • Firas Kour
    • 1
  • Lino M. Sawicki
    • 1
  • Ole Martin
    • 1
  • Johannes Bode
    • 2
  • Stephan vom Dahl
    • 2
  • Verena Keitel
    • 2
  • Dieter Häussinger
    • 2
  • Christina Antke
    • 3
  • Christian Buchbender
    • 1
  • Gerald Antoch
    • 1
  • Philipp Heusch
    • 1
  1. 1.Department of Diagnostic and Interventional Radiology, Medical FacultyUniversity DusseldorfDusseldorfGermany
  2. 2.Clinic for Gastroenterology, Hepatology and Infectious Diseases, Medical FacultyUniversity Hospital Düsseldorf, Heinrich-Heine-UniversityDüsseldorfGermany
  3. 3.Department of Nuclear Medicine, Medical FacultyUniversity DusseldorfDusseldorfGermany

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