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Noninvasive Assessment of Crohn's Disease Intestinal Lesions with ¹⁸F-FDG PET/CT

¹ Department of Gastroenterology, CHU of Liège, University of Liège, Liège, Belgium; ² Department of Nuclear Medicine, CHU of Liège, University of Liège, Liège, Belgium; and ³ Department of Medical Imaging, CHU of Liège, University of Liège, Liège, Belgium

View larger version (49K): [in this window] [in a new window]   FIGURE 1.  From left to right, examples of PET, CT, PET/CT, and corresponding endoscopic appearance. (A) Deep ulcers with cobblestones in left colon, appearing as thickened segment with prominent increase of 18F-FDG uptake on PET/CT. (B) No endoscopic lesion in cecum, contrasting with thickening of bowel wall and increased uptake of FDG on PET/CT.

View larger version (7K): [in this window] [in a new window]   FIGURE 2.  RSUV for each of 95 intestinal segments explored according to type of endoscopic lesion. RSUV (ratio of SUV in bowel segments over liver SUV) was significantly different in the 5 types of lesions (0 = no lesion; 1 = aphthoid ulcers, erythema, and pseudopolyps; 2 = superficial ulcers; 3 = deep ulcers and cobblestones; 4 = stricture). Bars indicate medians (median for type 0 lesion is 0) (P < 0.0001).

View larger version (8K): [in this window] [in a new window]   FIGURE 3.  Receiver operating characteristic curve of RSUV for detection of severe endoscopic lesions (types 3 and 4: deep ulcers and strictures). We deliberately selected a threshold with maximum sensitivity to allow detection of the vast majority of severe lesions. In our dataset, a threshold of 1.47 of RSUV gave a sensitivity of 100% for detection of severe lesions and a specificity of 67.1% for detection of any endoscopic lesion.