PET in Tumors of the Digestive Tract

  • Thomas F. Hany


The basic principle of positron emission tomography (PET) is the use of pharmaceuticals labeled with positron-emitting isotopes. These agents are such that they can be integrated into one of the body’s metabolic pathways. Positron-emitting isotopes are characterized by a beta plus-decay, in which a positron is emitted. This positron collides with any of the numerous shell electrons of neighboring atoms and the resulting annihilation produces two 511-keV gamma rays. These two photons are detected in coincidence by the PET scanner. Additionally, the use of an integrated PET/computed tomography (CT) machine allows PET and CT images of the patient to be acquired in the same imaging session. The clinically and most widely evaluated of the labeled pharmaceuticals is fluorine-18 fluoro-2-deoxy-D-glucose (18F-FDG). This glucose analogue is transported into the cell by specific transporters and phosphorylated by hexokinase to 18F-FDG-6 phosphate. The latter is inert to further metabolic processing or to transmembrane back-transport outside the cell and therefore accumulates intracellularly.


Positron Emission Tomography Rectal Cancer Standard Uptake Value National Comprehensive Cancer Network Primary Gastric Lymphoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    von Schulthess GK, Steinert HC, Hany TF (2006) Integrated PET/CT: current applications and future directions. Radiology 238:405–422CrossRefGoogle Scholar
  2. 2.
    Wei JT, Shaheen N (2003) The changing epidemiology of esophageal adenocarcinoma. Semin Gastrointest Dis 14: 112–127PubMedGoogle Scholar
  3. 3.
    Lerut T, Coosemans W, Decker G et al (2001) Cancer of the esophagus and gastro-esophageal junction: potentially curative therapies. Surg Oncol 10:113–122CrossRefPubMedGoogle Scholar
  4. 4.
    Vazquez-Sequeiros E, Wiersema MJ, Clain JE et al (2003) Impact of lymph node staging on therapy of esophageal carcinoma. Gastroenterology 125:1626–1635CrossRefPubMedGoogle Scholar
  5. 5.
    van Vliet EP, Heijenbrok-Kal MH, Hunink MG et al (2008) Staging investigations for oesophageal cancer: a meta-analysis. Br J Cancer 98:547–557CrossRefPubMedGoogle Scholar
  6. 6.
    Lordick F, Ott K, Krause BJ et al (2007) PET to assess early metabolic response and to guide treatment of adenocarcinoma of the oesophagogastric junction: the MUNICON phase II trial. Lancet Oncol 8:797–805CrossRefPubMedGoogle Scholar
  7. 7.
    Dassen AE, Lips DJ, Hoekstra CJ et al (2009) FDG-PET has no definite role in preoperative imaging in gastric cancer. Eur J Surg Oncol 35:449–455PubMedGoogle Scholar
  8. 8.
    Sim SH, Kim YJ, Oh DY et al (2009) The role of PET/CT in detection of gastric cancer recurrence. BMC Cancer 9:73CrossRefPubMedGoogle Scholar
  9. 9.
    Radan L, Fischer D, Bar-Shalom R et al (2008) FDG avidity and PET/CT patterns in primary gastric lymphoma. Eur J Nucl Med Mol Imaging 35:1424–1430CrossRefPubMedGoogle Scholar
  10. 10.
    Ambrosini V, Tomassetti P, Castellucci P et al (2008) Comparison between 68Ga-DOTA-NOC and 18F-DOPA PET for the detection of gastro-entero-pancreatic and lung neuroendocrine tumours. Eur J Nucl Med Mol Imaging 35:1431–1438CrossRefPubMedGoogle Scholar
  11. 11.
    Joensuu H, Roberts P J, Sarlomo-Rikala M et al (2001) Effect of the tyrosine kinase inhibitor STI571 in a patient with a metastatic gastrointestinal stromal tumor. N Engl J Med 344:1052–1056CrossRefPubMedGoogle Scholar
  12. 12.
    Goerres GW, Stupp R, Barghouth G et al (2004) The value of PET, CT and in-line PET/CT in patients with gastrointestinal stromal tumours: long-term outcome of treatment with imatinib mesylate. Comparison of PET, CT, and dual-modality PET/CT imaging for monitoring of imatinib (STI571) therapy in patients with gastrointestinal stromal tumors. Eur J Nucl Med Mol Imaging 4:4Google Scholar
  13. 13.
    Veit-Haibach P, Kuehle CA, Beyer T et al (2006) Diagnostic accuracy of colorectal cancer staging with whole-body PET/CT colonography. JAMA 296:2590–2600CrossRefPubMedGoogle Scholar
  14. 14.
    Choi H, Charnsangavej C, Faria SC et al (2007) Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol 25: 1753–1759CrossRefPubMedGoogle Scholar
  15. 15.
    Bade MA, Ohki T, Cynamon J, Veith FJ (2001) Hypogastric artery aneurysm rupture after endovascular graft exclusion with shrinkage of the aneurysm: significance of endotension from a “virtual,” or thrombosed type II endoleak. J Vasc Surg 33:1271–1274CrossRefPubMedGoogle Scholar
  16. 16.
    Clarke MP, Kane RA, Steele G Jr et al (1989) Prospective comparison of preoperative imaging and intraoperative ultrasonography in the detection of liver tumors. Surgery 106:849–855PubMedGoogle Scholar
  17. 17.
    Abdel-Nabi H, Doerr RJ, Lamonica DM et al (1998) Staging of primary colorectal carcinomas with fluorine-18 fluorodeoxyglucose whole-body PET: correlation with histopathologic and CT findings. Radiology 206:755–760PubMedGoogle Scholar
  18. 18.
    Kantorova I, Lipska L, Belohlavek O et al (2003) Routine (18)F-FDG PET preoperative staging of colorectal cancer: comparison with conventional staging and its impact on treatment decision making. J Nucl Med 44:1784–1788PubMedGoogle Scholar
  19. 19.
    Zervos EE, Badgwell BD, Burak WE Jr et al (2001) Fluoro-deoxyglucose positron emission tomography as an adjunct to carcinoembryonic antigen in the management of patients with presumed recurrent colorectal cancer and nondiagnostic radiologic workup. Surgery 130:636–643; discussion 643–634CrossRefPubMedGoogle Scholar
  20. 20.
    Goldberg RM, Fleming TR, Tangen CM et al (1998) Surgery for recurrent colon cancer: strategies for identifying resectable recurrence and success rates after resection. Eastern Cooperative Oncology Group, the North Central Cancer Treatment Group, and the Southwest Oncology Group. Ann Intern Med 129:27–35PubMedGoogle Scholar
  21. 21.
    Soyka JD, Veit-Haibach P, Strobel K et al (2008) Staging pathways in recurrent colorectal carcinoma: is contrast-enhanced 18F-FDG PET/CT the diagnostic tool of choice? J Nucl Med 49:354–361CrossRefPubMedGoogle Scholar
  22. 22.
    Even-Sapir E, Parag Y, Lerman H et al (2004) Detection of recurrence in patients with rectal cancer: PET/CT after abdominoperineal or anterior resection. Radiology 232:815–822CrossRefPubMedGoogle Scholar
  23. 23.
    Selzner M, Hany TF, Wildbrett P et al (2004) Does the novel PET/CT imaging modality impact on the treatment of patients with metastatic colorectal cancer of the liver? Ann Surg 240:1027–1034; discussion 1035-1026CrossRefPubMedGoogle Scholar
  24. 24.
    Kalff V, Duong C, Drummond EG et al (2006) Findings on 18F-FDG PET scans after neoadjuvant chemoradiation provides prognostic stratification in patients with locally advanced rectal carcinoma subsequently treated by radical surgery. J Nucl Med 47:14–22PubMedGoogle Scholar

Copyright information

© Springer Verlag Italia 2010

Authors and Affiliations

  • Thomas F. Hany
    • 1
  1. 1.Department of Radiology, Clinic and Policlinic of Nuclear MedicineUniversity Hospital ZurichZurichSwitzerland

Personalised recommendations