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¹⁸F-FDG PET Versus CT for the Detection of Enteropathy-Associated T-Cell Lymphoma in Refractory Celiac Disease

¹ Department of Gastroenterology, VU University Medical Center, Amsterdam, The Netherlands; ² Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands; ³ Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; and ⁴ Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, The Netherlands

Correspondence: For correspondence or reprints contact: Muhammed Hadithi, MD, Department of Gastroenterology, Vrije Universiteit Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. E-mail: m.hadithi{at}vumc.nl

Refractory celiac disease (RCD) can evolve into enteropathy-associated T-cell lymphoma (EATL). ¹⁸F-FDG PET has been reported to discriminate between RCD and EATL. Because prospective data are lacking, we designed a prospective study to evaluate the potential of ¹⁸F-FDG PET for detection of EATL in patients with RCD and compared the results with those obtained using abdominal CT in a referral center. Methods: Between April 2003 and April 2005, 8 consecutive patients (median age, 66 y; range, 52–89 y) with EATL and 30 patients (median age, 61 y; range, 44–71 y) with RCD were included. CT and ¹⁸F-FDG PET were performed on all patients. Histologic evidence of EATL was identified in tissue samples obtained during upper gastrointestinal endoscopy or surgical resection. Results: Villous atrophy was found in all patients with RCD and all (except 1) patients with EATL in nontumoral mucosa. Histologic examination of 1 patient with EATL localized in the duodenum showed intraepithelial lymphocytosis only. ¹⁸F-FDG PET could reveal sites histologically proven to be EATL in all 8 patients, whereas CT showed normal findings in 1 patient with EATL. ¹⁸F-FDG PET detected unsuspected extraintestinal sites affected by EATL in 2 patients. CT showed abnormalities such as a thickened small-bowel wall or lymphadenopathy in 14 patients with RCD lacking evidence of EATL at follow-up. ¹⁸F-FDG PET findings were positive in 3 and equivocal in another 3 patients with RCD. ¹⁸F-FDG PET was more sensitive and specific than CT (100% vs. 87% and 90% vs. 53%, respectively). Conclusion: Our data show that ¹⁸F-FDG PET is more sensitive in detecting EATL in patients with RCD than is CT. ¹⁸F-FDG PET, in addition to conventional CT, is recommended for evaluating patients with RCD.

Key Words: refractory celiac disease • enteropathy-associated T-cell lymphoma • computed tomography • positron emission tomography

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				A Al-toma, W H M Verbeek, M Hadithi, B M E von Blomberg, and C J J Mulder Survival in refractory coeliac disease and enteropathy-associated T-cell lymphoma: retrospective evaluation of single-centre experience Gut, October 1, 2007; 56(10): 1373 - 1378. [Abstract] [Full Text] [PDF]