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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: jnumed.109.065466v1 50/11/1751    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Related articles in JNM Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Jacene, H. A. Articles by Wahl, R. L. PubMed PubMed Citation Articles by Jacene, H. A. Articles by Wahl, R. L.

Prediction of the Need for Surgical Intervention in Obstructive Crohn's Disease by ¹⁸F-FDG PET/CT

¹ Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; ² Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; ³ Department of Medicine, Yale University, New Haven, Connecticut; ⁴ Department of Medicine, University of Toronto, Toronto, Ontario; and ⁵ Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland

Correspondence: For correspondence or reprints contact: Richard L. Wahl, 601 N. Caroline St., JHOC 3223, Baltimore, MD 21287. E-mail: rwahl{at}jhmi.edu

We preoperatively determined the accuracy of ¹⁸F-FDG PET/CT for differentiating fixed muscle hypertrophy and fibrotic stenoses from acute transmural inflammatory stenoses in patients with Crohn's disease (CD) scheduled to undergo surgical resection for obstructive symptoms. Methods: Seventeen patients with known CD prospectively underwent ¹⁸F-FDG PET/CT before already-planned surgery for obstructive symptoms. Image interpretation was by consensus of 2 readers with knowledge of patient participation in the study but not of other clinical history. Lesions were qualitatively graded on a 5-point scale for the presence of increased ¹⁸F-FDG uptake consistent with active inflammation. Maximum lean standardized uptake value (SUL_max) was determined for lesions scored 1 or more. Imaging results were compared with the pathologic grading of inflammation and predominant histopathologic subtype for each patient's surgical specimen, whether mainly inflammation, fibrosis, or muscle hypertrophy. Results: Thirteen of the 17 patients underwent surgery (median, 28 d after PET/CT; range, 2–148 d), and 12 of these 13 had histopathologic correlation. Despite the predominant histopathologic subtype (inflammation, 5; fibrosis, 4; and muscle hypertrophy, 3), acute and chronic inflammation, fibrosis (median, 50%; range, 40%–90%), and muscle hypertrophy (median, 20-fold thickening; range, 9- to 40-fold thickening) were found in all patients. SUL_max was significantly higher in severe than in mild-to-moderate chronic inflammation (8.2 ± 2.8 vs. 4.7 ± 2.5, P = 0.04). No patient with predominantly fibrosis or muscle hypertrophy (n = 7) had an SUL_max greater than 8. Visually, 10 of 12 patients on PET/CT were considered to have active inflammation of the bowel. Conclusion: Patients with CD who undergo surgery for obstructive symptoms have histopathologically mixed findings of inflammation, fibrosis, and muscle hypertrophy. Qualitative PET interpretations were quite sensitive, but additional semiquantitative analyses using SUL_max helped identify patients with active inflammation. This information may be beneficial for referring gastroenterologists considering medical therapy versus surgery for patients with CD who present with obstructive symptoms.

Key Words: Crohn's disease • ¹⁸F-FDG • PET/CT • stricture • inflammation

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JNM 2009 50: 11A-12A. [Full Text]