PET/CT colonography in patients with colorectal polyps: a feasibility study

Mainenti, Pier Paolo; Salvatore, Barbara; D’Antonio, Dario; Falco, Teresa; Palma, Giovanni Domenico De; D’Armiento, Francesco Paolo; Bucci, Luigi; Pace, Leonardo; Salvatore, Marco

doi:10.1007/s00259-007-0422-5

Cited by 28 publications

(33 citation statements)

References 11 publications

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“…In our study, the PET pixel size was a relatively large 5.47 mm. Our scan resolution is in contrast to the studies of Gollub et al (12) and Mainenti et al (13), in which the stated inplane resolution was below 3 and 4.2 mm, respectively. This difference in spatial resolution may have influenced our results for smaller polyps.…”

Section: Discussioncontrasting

confidence: 54%

“…If colonic neoplasia in laxative-free CT colonography were reliably highlighted via 18 F-FDG avidity, combined PET/CT colonography might have the potential to be a safe, well-tolerated, and accurate diagnostic test for clinically significant colorectal neoplasia in high-risk symptomatic patients. Although the technical feasibility of combined PET/CT colonography has been described previously (12)(13)(14)(15), most studies have used small cohorts and patients have undergone full purgation.…”

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confidence: 99%

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Nonlaxative PET/CT Colonography: Feasibility, Acceptability, and Pilot Performance in Patients at Higher Risk of Colonic Neoplasia

Taylor¹,

Bomanji²,

Manpanzure³

et al. 2010

J Nucl Med

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CT colonography without bowel preparation is a safer and bettertolerated alternative to full laxation protocols, but comparative sensitivity and specificity are potentially reduced. Uptake of 18 F-FDG by colonic neoplasia is well described, and combining PET with nonlaxative CT colonography could improve accuracy. The purpose was to prospectively test the technical feasibility and acceptability of combined nonlaxative PET/CT colonography in patients at higher risk of colorectal neoplasia and to provide pilot data on diagnostic performance. Methods: Fifty-six patients (median age, 64 y; 30 women) at high risk of colonic neoplasia underwent nonlaxative PET/CT colonography with barium fecal tagging within 2 wk of scheduled colonoscopy. Colonic segmental distension was graded 1 (poor) to 3 (good). A radiologist, experienced in CT colonography, and nuclear medicine physician in consensus analyzed the datasets. The diagnostic performance for standalone CT colonography and combined PET/CT colonography was compared with the reference colonoscopy. Patient experience for 25 items (each scored from 1 to 7) pertaining to satisfaction, worry, and physical discomfort was canvassed after both PET/CT colonography and colonoscopy. Results: Distension was good in 298 of 334 segments (89%; 95% confidence interval [CI], 85%292%). Patients experienced more physical discomfort during colonoscopy (median, 4; interquartile range [IQR], 2-7) than during PET/CT colonography (median, 5; IQR, 3-7; P 5 0.03) and were more willing to undergo PET/CT colonography again (36/43 [84%; 95% CI, 73%295%] vs. 31/43 [72%; 95% CI, 59%286%]; P 5 0.001). Twenty-one patients had 54 polyps according to colonoscopy (10 with at least 1 polyp $6 mm and 8 with at least 1 polyp $10 mm). Of 14 polyps 6 mm or greater, 12 (86%; 95% CI, 67%2100%) were 18 F-FDG-avid, including all those 10 mm or greater (mean standardized uptake value, 10.1). CT colonography sensitivity for polyps 6 mm or larger was 92.9% (95% CI, 79.4%2100%) and was not improved by the addition of PET. However, combined PET/CT colonography review improved per-patient positive predictive value for a polyp 10 mm or greater from 73% (95% CI, 39-92) to 100% (95% CI, 60-100). Conclusion: In this feasibility study, simultaneous PET acquisition during nonlaxative CT colonography is technically feasible, is well tolerated, and potentially improves specificity.

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Section: Discussioncontrasting

confidence: 54%

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confidence: 99%

Nonlaxative PET/CT Colonography: Feasibility, Acceptability, and Pilot Performance in Patients at Higher Risk of Colonic Neoplasia

Taylor¹,

Bomanji²,

Manpanzure³

et al. 2010

J Nucl Med

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“…However, this approach is still in the initial phases of development, 11,31,32 and preliminary studies have demonstrated that integrated PET and CT colonography has only a limited ability to detect adenomas <10 mm. 8,9,33 The most frequent use of PET-CT in our study group was for staging or surveillance of patients with lymphoma. Our data showing 8 of 87 lymphoma patients with colonic involvement missed by PET-CT suggests a need to verify imaging results.…”

Section: Discussionmentioning

confidence: 99%

“…7 Integrating PET with CT colonography has been suggested as a way to screen patients for colorectal neoplasia. 8,9 Occasionally, PET-CT will reveal intense metabolic activity at sites not considered to be involved with the malignant process under study. One common site for such incidental activity is the colon.…”

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confidence: 99%

Ability of integrated positron emission and computed tomography to detect significant colonic pathology

Weston

Iyer

Qiao

et al. 2010

Cancer

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BACKGROUND:The ability of integrated positron emission tomography and computed axial tomography (PET‐CT) to detect colonic pathology is not fully defined. The purpose of this study was to assess the ability of PET‐CT to detect colonic pathology and to determine the significance of (18F)2‐fluoro‐2‐deoxyglucose (18F‐FDG) activity noted incidentally in the colon on PET‐CT.METHODS:Records for all patients who underwent PET‐CT and colonoscopy at our institution were reviewed. Patients with history of colonic malignancy or colon surgery were excluded.RESULTS:Fifty‐eight patients had incidental colonic 18F‐FDG activity on PET (Group A) and 272 had none (Group B). In Group A, 65% of patients had pathologic findings detected on colonoscopy that corresponded to the site of PET activity. Standardized uptake value (SUV) readings were not helpful in distinguishing true‐positives from false‐positives. In Group B, 11.8% of patients were found to have significant colonic findings. Lesions not detected by PET‐CT included 4 colon cancers, 7 advanced adenomas, and 10 patients with colonic lymphoma. Overall, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET‐CT for detecting significant pathology were 53%, 93%, 65%, 89%, and 85%, respectively. For detecting colon cancer and adenomas 10 mm or more, the sensitivity, specificity, PPV, NPV, and accuracy of PET‐CT were 72%, 90%, 45%, 96%, and 88%, respectively.CONCLUSIONS:Incidental colonic activity detected by PET‐CT warrants further evaluation with colonoscopy. However, negative PET‐CT does not rule out significant colonic pathology including colon cancer, advanced adenomas, or lymphoma. Cancer 2010. © 2010 American Cancer Society.

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“…18 F-FDG is actively taken up and accumulates in tumor cells (7). In humans, colorectal adenomas are detected by 18 F-FDG PET to a variable extent depending on adenoma characteristics (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). 18 F-FDG PET in a mouse model of intestinal adenomas has not been reported.…”

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confidence: 99%

Total Abdominal ¹⁸F-FDG Uptake Reflects Intestinal Adenoma Burden in Apc Mutant Mice

et al. 2011

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Apc mutant (Apc Min ) mice develop multiple adenomas in their intestines and are widely used to study colorectal carcinogenesis and chemopreventive approaches. Molecular imaging of intestinal adenomas could potentially provide noninvasive longitudinal evaluation of these lesions in living mice. Therefore, the aim of this study was to investigate the role of 18 F-FDG PET in the Apc Min mouse model. Methods: Apc Min mice (n 5 8) fed a purified diet were imaged serially after injection of 18 F-FDG at age 9 and 12 wk using a small-animal PET scanner. Abdominal uptake of the tracer was quantified. After dissection, intestines were imaged separately, and intestinal tracer uptake was quantified. Tracer distribution was compared with results from microscopic examination regarding adenoma number and size. Thereafter, findings were validated serially in 20 Apc Min mice aged 6, 8, 10, and 12 wk that received standard chow to increase adenoma numbers. In vivo abdominal 18 F-FDG uptake was correlated with microscopy results. Results: Microscopic examination showed that the mice developed 25-35 intestinal adenomas at age 12 wk. Ex vivo 18 F-FDG PET of the dissected intestines visualized all large adenomas and most small adenomas. Ex vivo total intestinal 18 F-FDG uptake correlated with in vivo total abdominal uptake and with the number of large adenomas at age 9 and 12 wk. At 12 wk, there was a clear correlation between in vivo abdominal tracer uptake and the number of large adenomas but not the total number of lesions. Conclusion: Intestinal adenomas in Apc Min mice are metabolically active lesions that take up 18 F-FDG. Abdominal 18 F-FDG uptake at age 12 wk serves as a readout modality for large intestinal adenomas.

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PET/CT colonography in patients with colorectal polyps: a feasibility study

Abstract: PET/CTc is a feasible study. Adding a colonographic protocol to PET/CT images seems to allow correct characterisation of all cases of colorectal focal radiotracer uptake. The metabolic information does not seem to increase the accuracy of CTc.

Cited by 28 publications

References 11 publications

Nonlaxative PET/CT Colonography: Feasibility, Acceptability, and Pilot Performance in Patients at Higher Risk of Colonic Neoplasia

Nonlaxative PET/CT Colonography: Feasibility, Acceptability, and Pilot Performance in Patients at Higher Risk of Colonic Neoplasia

Ability of integrated positron emission and computed tomography to detect significant colonic pathology

Total Abdominal ¹⁸F-FDG Uptake Reflects Intestinal Adenoma Burden in Apc Mutant Mice

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PET/CT colonography in patients with colorectal polyps: a feasibility study

Abstract: PET/CTc is a feasible study. Adding a colonographic protocol to PET/CT images seems to allow correct characterisation of all cases of colorectal focal radiotracer uptake. The metabolic information does not seem to increase the accuracy of CTc.

Cited by 28 publications

References 11 publications

Nonlaxative PET/CT Colonography: Feasibility, Acceptability, and Pilot Performance in Patients at Higher Risk of Colonic Neoplasia

Nonlaxative PET/CT Colonography: Feasibility, Acceptability, and Pilot Performance in Patients at Higher Risk of Colonic Neoplasia

Ability of integrated positron emission and computed tomography to detect significant colonic pathology

Total Abdominal 18F-FDG Uptake Reflects Intestinal Adenoma Burden in Apc Mutant Mice

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Total Abdominal ¹⁸F-FDG Uptake Reflects Intestinal Adenoma Burden in Apc Mutant Mice