Detection of incidental colorectal pathology on positron emission tomography/computed tomography

Mui, Milton; Akhurst, Timothy; Warrier, Satish; Lynch, A. C.; Heriot, Alexander G.

doi:10.1111/ans.13739

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…In our study, 36 of the 56 sites evaluated with unexpected colonic FDG uptake in PET/CT corresponded to an abnormal finding in colonoscopy and gave us a positive predictive value of 64.2%, which was consistent with the value found in the literature between 47 and 63%. [13–16]. Also, the malignant and premalignant lesions had a significantly higher median SUVmax than false positive ones, consistent with current literature [17].…”

Section: Discussionsupporting

confidence: 87%

Evaluation of Colonoscopic Results of Patients with Incidental Colonic FDG Uptake in PET/CT Imaging

et al. 2023

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Background Colorectal cancer is a significant global health concern, ranking as the second most deadly and third most common cancer worldwide. Early detection and removal of precancerous lesions play a crucial role in preventing cancer development and reducing mortality. Since FDG uptake is not specific for malignancy, incidental increased FDG uptake in the gastrointestinal tract may be challenging to interpret and may require further colonoscopic examination. This study aimed to investigate the features associated with malignant and premalignant pathology in patients with incidental colonic FDG uptake and determine the necessity of colonoscopy for each FDG uptake. Methods Retrospective analysis was performed on data from patients who underwent colonoscopies between January 2016 and December 2021. Patients with FDG uptake in known colorectal malignancy regions were excluded. The study included 56 patients with incidental colonic FDG uptake. PET/CT images were visually and quantitatively analyzed, and the corresponding colonoscopy and histopathological results were recorded. Statistical analyses were conducted to evaluate the relationship between FDG uptake patterns, SUVmax values, and histopathological diagnoses. Colonoscopic findings were categorized as malignancy, polyps, and non-neoplastic lesions. Results Among the 56 patients with incidental colonic FDG uptake, 36 lesions were identified, and histopathology revealed malignancy in 10 (17.9%) patients and premalignant polyps in the 26 (46.4%) cases. Focal FDG uptake with corresponding wall thickening or soft tissue density on CT was associated with a higher likelihood of premalignant or malignant lesions. The SUVmax values demonstrated a significant difference between negative findings and polyps/malignancies. However, no significant difference was observed between malignant and premalignant lesions. A ROC curve analysis was made and assesed a cut-off value of 11.1 SUVmax (sensitivity: 83.3% and specificity: 90%) to distinguish premalignant or malignant lesions from non-malignant lesions. Conclusion Incidental colonic FDG uptake with a focal pattern and corresponding CT findings were more likely to indicate premalignant or malignant lesions. SUVmax values were helpful in predicting the presence of pathological findings, but histopathological verification remains necessary for a definitive diagnosis. These findings contribute to our understanding of the clinical implications of incidental colonic FDG uptake and highlight the importance of follow-up colonoscopy for further evaluation.

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Section: Discussionsupporting

confidence: 87%

Evaluation of Colonoscopic Results of Patients with Incidental Colonic FDG Uptake in PET/CT Imaging

et al. 2023

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“…In contrast to neoplastic lesions, the RIs were significant in separating benign lesions from physiologic uptake. Inflammatory lesions are presumably 18 F-FDG-avid on PET/CT because of the increased metabolism of inflammatory cells [ 5 ]. Hyperplastic polyps are usually considered benign nonneoplastic lesions of the colorectum, and their metabolic behavior is controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Unexpectedly increased 18 F-FDG uptake in the large bowel can be focal, segmental, or diffuse in pattern [ 3 ]. Focal unexpected colorectal 18 F-FDG uptake might correspond to malignant or premalignant lesions [ 2 , 4 , 5 ], whereas segmental or diffuse colorectal 18 F-FDG uptake is more frequently associated with physiologic or inflammatory changes [ 6 ]. However, it is difficult to differentiate physiologic or benign lesions from neoplastic lesions.…”

Section: Introductionmentioning

confidence: 99%

“…Many studies have attempted to differentiate such lesions through various methods, such as analysing the pattern, location, double-phase PET scan and PET parameters such as the maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumour volume (MTV), or total lesion glycolysis (TLG), but a consensus has not yet been reached [ 2 , 7 – 13 ]. A subsequent colonoscopy is recommended in patients with colorectal incidental 18 F-FDG uptake, especially for focal 18 F-FDG uptake [ 5 , 14 , 15 ]. However, due to the nonspecific 18 F-FDG uptake of lesions and many false-positive results, some patients may be subjected to unnecessary invasive colonoscopies.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of water enema PET/CT: an effective imaging technique for the diagnosis of incidental colorectal 18F-FDG uptake

Zhang,

Abudurexiti,

Qiu

et al. 2024

BMC Med Imaging

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Background To validate the feasibility of water enema PET/CT (WE-PET/CT) in incidental colorectal 18F-FDG uptake and improve the accuracy of diagnosing colorectal neoplastic lesions. Methods We retrospectively analysed the electronic records of 338 patients undergoing common PET/CT and WE-PET/CT at our hospital. PET/CT results were correlated with colonoscopy pathology and follow-up results. The ROC contrast curve was plotted to evaluate the accuracy of SUVmax on common PET/CT and WE-PET/CT for detecting neoplastic lesions. SUVmax and the median retention indexes (RIs) of cancerous, precancerous, and benign lesions and physiologic uptake were compared. Results The sensitivity, specificity and accuracy of diagnosing neoplastic lesions with common PET/CT were 84.0%, 78.3% and 80.2%, respectively. The corresponding results with WE-PET/CT were 95.8%, 96.5% and 96.2%. The AUC of SUVmax on WE-PET/CT was significantly higher than that on common PET/CT (0.935 vs. 0.524, p < 0.001). The median SUVmax on WE-PET/CT was significantly higher than that on common PET/CT in cancerous and precancerous lesions, and significantly decreased in benign lesions and physiologic uptake (p < 0.001). The RI was significantly different between cancerous lesions and physiologic uptake, between precancerous lesions and physiologic uptake, between benign lesions and physiologic uptake, and between cancerous and benign lesions (p < 0.05). Conclusions WE-PET/CT is a noninvasive, well-tolerated and effective technique for diagnosing incidental colorectal 18F-FDG uptake. It is helpful for a timely colonoscopy and can effectively avoid an unnecessary colonoscopy for incidental colorectal 18F-FDG uptake.

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Advancements in colorectal cancer detection: The role of immuno‐positron emission tomography, immuno‐single‐photon emission computed tomography, and machine learning applications

Chen,

Shi,

Liu

et al. 2024

Journal of Intelligent Medicine

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Colorectal cancer (CRC) ranks as the world's second most prevalent cancer and third in mortality. Detection and diagnosis are crucial in research and clinical settings. While colonoscopy and computed tomographic colonography are widely used for identifying organic lesions, positron emission tomography (PET) and single‐photon emission computed tomography (SPECT) offer superior visualization of molecular changes. These immuno‐PET and immuno‐SPECT techniques surpass conventional [18F] Fluorodeoxyglucose PET/CT in specificity and sensitivity, improving CRC diagnostics and supporting therapeutic strategies. This review emphasizes the role of immuno‐PET/SPECT in CRC diagnosis and establishing a foundation for therapeutic strategies, facilitating hierarchical management through the identification of treatment‐responsive populations, prediction of therapeutic outcomes, and support for intraoperative imaging. This review introduces the preclinical and clinical utility of immunoconjugates for detecting colorectal adenomas, and primary, metastatic, or recurrent CRC, focusing on specific CRC cell targets like the epidermal growth factor receptor and carcinoembryonic antigen. The review also covers various mAb‐based immunoconjugates and engineered mAb fragments, including diabodies and minibodies. Finally, it looks into the great promise of machine learning in PET or SPECT and it addresses the challenges of translating preclinical successes into clinical practice for colorectal adenoma diagnosis, proposing potential solutions and directions for future research.

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Detection of incidental colorectal pathology on positron emission tomography/computed tomography

Abstract: Focal colorectal F-FDG uptake on PET/CT is associated with a significant proportion of malignant or pre-malignant lesions. Further evaluation with colonoscopy is recommended.

Cited by 7 publications

References 20 publications

Evaluation of Colonoscopic Results of Patients with Incidental Colonic FDG Uptake in PET/CT Imaging

Evaluation of Colonoscopic Results of Patients with Incidental Colonic FDG Uptake in PET/CT Imaging

Assessment of water enema PET/CT: an effective imaging technique for the diagnosis of incidental colorectal 18F-FDG uptake

Advancements in colorectal cancer detection: The role of immuno‐positron emission tomography, immuno‐single‐photon emission computed tomography, and machine learning applications

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