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OtherClinical Investigations

PET/CT Detection of Unexpected Gastrointestinal Foci of 18F-FDG Uptake: Incidence, Localization Patterns, and Clinical Significance

Ora Israel, Nikolay Yefremov, Rachel Bar-Shalom, Olga Kagana, Alex Frenkel, Zohar Keidar and Doron Fischer
Journal of Nuclear Medicine May 2005, 46 (5) 758-762;
Ora Israel
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Nikolay Yefremov
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Rachel Bar-Shalom
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Olga Kagana
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Alex Frenkel
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Zohar Keidar
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Doron Fischer
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  • FIGURE 1.
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    FIGURE 1.

    Focal 18F-FDG uptake in 57-y-old woman who had undergone total gastrectomy for stomach cancer and was being evaluated for fatigue, abdominal pain, frequent vomiting, equivocal endoscopic findings at level of anastomosis, and negative findings on whole-body CT. (A) From left to right, coronal, sagittal, and transaxial PET slices show focus of increased 18F-FDG uptake (arrows) in left lower abdomen. (B) Area of increased uptake (arrows) was localized by PET/CT (left panel) to small bowel, as seen on corresponding CT image (right panel). PET/CT-guided surgery revealed small-bowel metastasis originating from primary gastric cancer. No abnormal 18F-FDG uptake was seen in region of anastomosis, and there was no further evidence of disease in this area.

  • FIGURE 2.
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    FIGURE 2.

    Focal 18F-FDG uptake in 64-y-old woman who was being evaluated for staging of aggressive non-Hodgkin’s lymphoma. (A) From left to right, coronal, sagittal, and transaxial PET slices show focus of increased 18F-FDG uptake (arrows) in left pelvis. Coronal and sagittal PET images show additional areas of abnormal 18F-FDG uptake in mediastinum and left upper abdomen (open arrows), consistent with sites of active lymphoma. (B) Pelvic area of increased uptake (arrows) was localized by PET/CT (left panel) to sigmoid, as seen on corresponding CT image (right panel). Villous adenoma was diagnosed from biopsy sample taken during colonoscopy.

  • FIGURE 3.
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    FIGURE 3.

    Focal 18F-FDG uptake in 70-y-old woman with low-grade non-Hodgkin’s lymphoma who was undergoing routine follow-up examination. (A) Coronal, sagittal, and transaxial PET slices show focus of increased 18F-FDG uptake (arrows) in right upper abdomen. (B) Area of increased uptake (arrows) was localized by PET/CT (left panel) to ascending colon, as seen on corresponding CT image (right panel). Colonoscopy had negative findings, and patient showed no evidence of disease after 16 mo of follow-up. Focus of increased 18F-FDG uptake was considered to represent physiologic bowel activity.

Tables

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    TABLE 1

    Incidental 18F-FDG Foci in GIT: Diagnosis, Localization, and Intensity of Uptake

    ParameterMalignantPremalignantBenignPhysiologic
    Foci (n)119410
    Anatomic site
        Stomach3—1—
        Small intestine2———
        Colon69310
    SUVmax
        Mean ± SD17.3 ± 10.214.0 ± 10.518.0 ± 12.111.1 ± 7.4
        Range8.1–40.34.5–408.7–35.65.7–30.8
    • View popup
    TABLE 2

    Localization and Etiology of 34 Foci of Incidental GIT Uptake of 18F-FDG

    PET/CT focusDiagnosis
    LocationPatients (n)On referral to PET/CTAfter PET/CTPatients (n)
    Stomach4SPNGastric cancer2
    Colon cancerSecond primary gastric cancer1
    Colon cancerActive gastritis1
    Small bowel2Stomach cancerMetastasis1
    Colon cancerMetastasis1
    Colon28MCUOColon cancer1
    SPNColon cancer1
    Lung cancerSecond primary colon cancer2
    Lung cancerMetastasis1
    Colon cancerMetastasis1
    LymphomaVillous adenoma2
    Colon cancerVillous adenoma2
    Lung cancerAdenomatous polyp with low-grade dysplasia2
    Breast cancerAdenomatous polyp with low-grade dysplasia1
    HistiocytomaVillous adenoma1
    SPNTubular adenoma1
    LymphomaBenign polyps (hamartomatous and serrated)2
    SarcomaAbscess of sigmoid1
    LymphomaPhysiologic uptake3
    Colon cancerPhysiologic uptake3
    Esophagus cancerPhysiologic uptake1
    Lung cancerPhysiologic uptake1
    SPNPhysiologic uptake1
    MCUOPhysiologic uptake1
    • SPN = single pulmonary nodule; MCUO = metastatic cancer of unknown origin.

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Journal of Nuclear Medicine: 46 (5)
Journal of Nuclear Medicine
Vol. 46, Issue 5
May 1, 2005
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PET/CT Detection of Unexpected Gastrointestinal Foci of 18F-FDG Uptake: Incidence, Localization Patterns, and Clinical Significance
Ora Israel, Nikolay Yefremov, Rachel Bar-Shalom, Olga Kagana, Alex Frenkel, Zohar Keidar, Doron Fischer
Journal of Nuclear Medicine May 2005, 46 (5) 758-762;

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PET/CT Detection of Unexpected Gastrointestinal Foci of 18F-FDG Uptake: Incidence, Localization Patterns, and Clinical Significance
Ora Israel, Nikolay Yefremov, Rachel Bar-Shalom, Olga Kagana, Alex Frenkel, Zohar Keidar, Doron Fischer
Journal of Nuclear Medicine May 2005, 46 (5) 758-762;
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