Incidental Focal Colonic Uptake of 18F-fluorodeoxyglucose on Positron Emission Tomography/Computed Tomography: Its Incidence and Clinical Significance

Hui, YH; Kung, BT; Yong, TK Au

doi:10.12809/hkjr2017040

Cited by 5 publications

(3 citation statements)

References 15 publications

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“…Similar findings regarding focal colonic uptake and underlying colonic polypoid lesion detection in FDG PET/CT have also been reported in our centre, with a prevalence of focal colonic uptake of 4.8%, comparable to previous studies. 10,11 It has been suggested that increased bowel activity (SUVmax >5.9) encountered without discontinuing metformin would obscure focal colonic uptake detection and hinder appropriate management, such as colonoscopy or virtual colonoscopy according to an evidence-based review. 12 Further study is warranted to evaluate the true incidence of focal colonic uptake after metformin discontinuation.…”

Section: Discussionmentioning

confidence: 99%

Metformin Discontinuation for 48 Hours Reduces Intestinal Fluorodeoxyglucose Uptake in 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

Hui

Chu

et al. 2021

Hong Kong Journal of Radiology

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Objective: To evaluate the effect of 48-hour metformin discontinuation on bowel fluorodeoxyglucose (FDG) uptake in a Chinese population undergoing 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging. Methods: All patients with known type 2 diabetes mellitus treated with metformin who had had a previous FDG PET/CT examination performed in our centre, and who were scheduled for a second FDG PET/CT examination within 1 year of the first one, were recruited. These subjects were advised to stop metformin for 48 hours prior to the second examination. The intestinal uptakes were graded visually by a four-point scale and semiquantitatively by maximum standardised uptake value (SUVmax) of small and large bowel segments. Any differences in intestinal uptake, as well as other differences in examination day blood glucose levels between the two successive examinations were compared. Results: In total, 44 patients were included. Metformin discontinuation resulted in a significant reduction in small and large bowel uptake by visual scoring. The SUVmax values were significantly lower in all bowel segments except duodenum. Examination day blood glucose levels after 48-hour metformin discontinuation were <11 mmol/L, in all examinations. Conclusion: Metformin discontinuation for 48 hours prior to scanning significantly reduced intestinal uptake and should be considered as a method to improve PET/CT interpretation.

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Section: Discussionmentioning

confidence: 99%

Metformin Discontinuation for 48 Hours Reduces Intestinal Fluorodeoxyglucose Uptake in 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

Hui

Chu

et al. 2021

Hong Kong Journal of Radiology

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“…Incidental colorectal FDG uptake is up to around 5%[ 170 - 172 ]. Focal uptake has more chance to be malignant[ 173 ].…”

Section: Incidental Focal F-18 Fdg Uptake By Organsmentioning

confidence: 99%

Unexpected focal fluorodeoxyglucose uptake in main organs; pass through or pass by?

Lee,

Hwang

2024

World J Clin Cases

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Since the inception of fluorine-18 fluorodeoxyglucose (F-18 FDG), positron emission tomography/computed tomography (PET/CT) utilizing F-18 FDG has become widely accepted as a valuable imaging modality in the field of oncology, with global prevalence in clinical practice. Given that a single Torso PET/CT scan encompasses the anatomical region from the skull base to the upper thigh, the detection of incidental abnormal focal hypermetabolism in areas of limited clinical interest is both feasible and not uncommon. Numerous investigations have been undertaken to delineate the distinctive features of these findings, yet the outcomes have proven inconclusive. The incongruent results of these studies present a challenge for physicians, leaving them uncertain about the appropriate course of action. This article provides a succinct overview of the characteristics of fluorodeoxyglucose, followed by a comprehensive discussion of the imaging findings and clinical significance associated with incidental focal abnormal F-18 FDG activity in several representative organs. In conclusion, while the prevalence of unrecognized malignancy varies across organs, malignancies account for a substantial proportion, ranging from approximately one-third to over half, of incidental focal uptake. In light of these rates, physicians are urged to exercise vigilance in not disregarding unexpected uptake, facilitating more assured clinical decisions, and advocating for further active evaluation.

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“…Incidental colorectal FDG uptake occurs in approximately 5% of cases[ 76 - 78 ], with focal uptake presenting a higher likelihood of malignancy compared to diffuse patterns[ 71 ]. Diffuse and segmental uptake may stem from inflammation, physiological processes, or FDG excretion[ 79 , 80 ], generally associated with a lower risk of malignancy.…”

Section: Colorectal Incidental Focal F-18 Fdg Uptakementioning

confidence: 99%

Focal incidental colorectal fluorodeoxyglucose uptake: Should it be spotlighted?

Lee,

Hwang

2024

World J Clin Cases

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Fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) has emerged as a cornerstone in cancer evaluation imaging, with a well-established history spanning several years. This imaging modality, encompassing the examination of the body from the base of the skull to the upper thighs, comprehensively covers the chest and abdominopelvic regions in a singular scan, allowing for a holistic assessment of nearly the entire body, including areas of marginal interest. The inherent advantage of this expansive scan range lies in its potential to unveil unexpected incidental abnormal hypermetabolic areas. The identification of incidental focal FDG uptake within colorectal regions during PET/CT scans is not an uncommon occurrence, albeit fraught with challenges associated with non-specific FDG uptake. The presence of benign colorectal lesions or physiological uptake poses a particular obstacle, as these may manifest with FDG uptake levels that mimic malignancy. Consequently, physicians are confronted with a diagnostic dilemma when encountering abnormal FDG uptake in unexpected colorectal areas. Existing studies have presented divergent results concerning these uptakes. Standardized uptake value and its derivatives have served as pivotal metrics in quantifying FDG uptake in PET images. In this article, we aim to succinctly explore the distinctive characteristics of FDG, delve into imaging findings, and elucidate the clinical significance of incidental focal colorectal uptake. This discussion aims to contribute valuable insights into the nuanced interpretation of such findings, fostering a comprehensive understanding.

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Incidental Focal Colonic Uptake of 18F-fluorodeoxyglucose on Positron Emission Tomography/Computed Tomography: Its Incidence and Clinical Significance

Cited by 5 publications

References 15 publications

Metformin Discontinuation for 48 Hours Reduces Intestinal Fluorodeoxyglucose Uptake in 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

Metformin Discontinuation for 48 Hours Reduces Intestinal Fluorodeoxyglucose Uptake in 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

Unexpected focal fluorodeoxyglucose uptake in main organs; pass through or pass by?

Focal incidental colorectal fluorodeoxyglucose uptake: Should it be spotlighted?

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