Low-Dose F-18-FDG PET/CT Enterography: Improving on CT Enterography Assessment of Patients with Crohn Disease


Shyn P. B., Mortele K. J., Britz-Cunningham S. H., Friedman S., Odze R. D., Burakoff R., ...More

JOURNAL OF NUCLEAR MEDICINE, vol.51, no.12, pp.1841-1848, 2010 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 51 Issue: 12
  • Publication Date: 2010
  • Doi Number: 10.2967/jnumed.110.080796
  • Journal Name: JOURNAL OF NUCLEAR MEDICINE
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.1841-1848
  • Keywords: Crohn disease, F-18-FDG, PET, CT enterography, POSITRON-EMISSION-TOMOGRAPHY, NONINVASIVE ASSESSMENT, BOWEL WALL, CONTRAST, ENTEROCLYSIS, INFLAMMATION, ATTENUATION, VALIDATION, RESONANCE, THERAPY
  • Istanbul University Affiliated: No

Abstract

The purpose of this study was to evaluate the diagnostic efficacy of low-dose, combined F-18-FDG PET/CT enterography (PET/CTE), compared with CT enterography (CTE) alone, in the assessment of patients with Crohn disease. Methods: Thirteen patients with Crohn disease were prospectively enrolled in this pilot study and underwent abdominal-pelvic F-18-FDG PET/CTE using neutral oral and intravenous contrast medium. The effective dose from PET/CTE was 17.7 mSv for the first 4 patients and 8.31 mSv for the last 9 patients. Six patients underwent surgical resection of the bowel, and 7 patients underwent colonoscopy with biopsies within 27 d (mean, 12 d) of PET/CTE. PET/CTE and CTE images were each visually assessed for Crohn disease involvement in 54 bowel segments with pathology correlation. Extraintestinal findings were recorded. A CTE severity score, maximum standardized uptake value (SUVmax), SUVmax ratio, simplified endoscopic score, and clinical parameters were correlated with pathology inflammation grade, on a per-patient basis and on a per-bowel-segment basis, using Spearman correlation. Results: In 3 (23.1%) of 13 patients, F-18-FDG uptake using PET/CTE revealed active inflammation in a bowel segment not evident using CTE (n = 2) or revealed an enterocolic fistula missed with CTE (n = 1). Visual interpretation of both PET/CTE and CTE images detected the presence of disease in all bowel segments with more than mild inflammation (sensitivity, 100%; specificity, 89.7%; positive predictive value, 78.9%; and negative predictive value, 100%). Correlation to inflammation grade per patient was the strongest for the SUVmax ratio (0.735, P = 0.004) and SUVmax (0.67, P = 0.013), as compared with the CTE score (0.62, P = 0.024). Correlation with inflammation per bowel segment was higher for the CTE score (0.79, P < 0.0001) than the SUVmax ratio (0.62, P < 0.0001) or SUVmax (0.48, P < 0.0001). SUVmax correlated strongly with serum C-reactive protein (0.82, P = 0.023), but CTE score did not. Conclusion: Low-dose F-18-FDG PET/CTE, compared with CTE, may improve the detection and grading of active inflammation in patients with Crohn disease. PET/CTE also may reveal clinically significant findings, such as enterocolic fistula, not evident on PET or CTE alone.