Rifaximin suppresses background intestinal 18F-FDG uptake on PET/CT scans

Franquet, Elisa; PALMER, M.; Gifford, Anne; Selen, Daryl J.; Chen, Yih-Chieh S.; Sedora‐Roman, Neda I.; Joyce, Robin; Kolodny, Gerald M.; Moss, Alan C.

doi:10.1097/mnm.0000000000000170

Cited by 14 publications

(19 citation statements)

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“…Rifaximin was reported to prevent stress-induced mucosal inflammation, intestinal barrier impairment, and visceral hyperalgesia, which was linked to enhanced gut permeability. It is possible that contrary to previous suggestions [ 4 ], suppressed intestinal FDG activity by rifaximin might be due to improved intestinal permeability rather than a bactericidal effect.…”

Section: Discussioncontrasting

confidence: 86%

“…A previously mentioned study [ 4 ] demonstrated suppressed bowel FDG uptake by Rifaximin and showed that bacteria are responsible for the retention of FDG. Accordingly, FDG activity is predicted to be determined by the number of bacteria.…”

Section: Discussionmentioning

confidence: 99%

“…Franquet et al reported that physiologic bowel FDG uptake was suppressed by antibiotics, such as rifaximin [ 4 ]. They suggested that bacteria play a role in accumulating FDG and may ingest FDG that has migrated into the intestinal lumen via transcellular translocation.…”

Section: Introductionmentioning

confidence: 99%

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Gut microbiota and physiologic bowel 18F-FDG uptake

et al. 2017

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BackgroundWe investigated the association between physiologic bowel FDG uptake and gut microbiota. FDG uptake in the normal large and small intestine is widely variable both in distribution and intensity. The etiology of physiologic bowel 18F-FDG activity remains unknown.ResultsWe included 63 healthy male subjects. After overnight fasting, blood samples and 18F-FDG PET/CT scans were taken. Fecal samples were collected, and gut microbiota were analyzed by 16S rRNA gene-pyrosequencing. The physiologic bowel FDG uptake was classified into three groups by visual assessment and measured using the maximum and mean standardized uptake value. We used the total bowel to liver uptake ratio (TBRmax and TBRmean). There was no significant difference in age, BMI, or lipid profiles between groups. To identify specific microbial taxa associated with the bowel FDG uptake while accounting for age and BMI, we performed a generalized linear model. At the genus level, the group with focal or intense FDG uptake in the intestine was associated with low abundance of unclassified Clostridiales. The group with intestinal FDG uptake lower than the liver was associated with high abundance of Klebsiella. TBRmax and TBRmean were negatively associated with abundance of unclassified Enterobacteriaceae.ConclusionWe cautiously speculate that physiologic bowel FDG activity might be caused by an increase in intestinal permeability and may reflect an impaired barrier function in the intestine.Electronic supplementary materialThe online version of this article (doi:10.1186/s13550-017-0318-8) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Gut microbiota and physiologic bowel 18F-FDG uptake

et al. 2017

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“…However, these two latter factors can be effectively overcome by a proper distention of bowel segments through the administration of great amount of fluids, as in the case of PET/CT enterography[1,3,7,20,21]. To reduce the number of false positive findings in the intestinal tract during a PET scan, Franquet et al[22] proposed to undertake a therapy with Rifaximine 2 d before the PET scan. In their paper, this patient preparation allowed to reduce the unspecific FDG uptake.…”

Section: Resultsmentioning

confidence: 99%

“…Indeed, false positive cases due to physiologic uptake of the radiopharmaceutical in normal bowel can be often found in clinical practice. However, false positive findings can be effectively reduced with a proper distention of bowel segments through the administration of great amount of fluids[1,3,7,20,21] or by specific patients preparations as reported by Franquet et al[22]. …”

Section: Discussionmentioning

confidence: 99%

Role of molecular imaging in the management of patients affected by inflammatory bowel disease: State-of-the-art

Caobelli

Evangelista

Quartuccio

et al. 2016

WJR

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AIMTo present the current state-of-the art of molecular imaging in the management of patients affected by inflammatory bowel disease (IBD).METHODSA systematic review of the literature was performed in order to find important original articles on the role of molecular imaging in the management of patients affected by IBD. The search was updated until February 2016 and limited to articles in English.RESULTSFifty-five original articles were included in this review, highlighting the role of single photon emission tomography and positron emission tomography.CONCLUSIONTo date, molecular imaging represents a useful tool to detect active disease in IBD. However, the available data need to be validated in prospective multicenter studies on larger patient samples.

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Can physiologic colonic [18F]FDG uptake in PET/CT imaging predict response to immunotherapy in metastatic melanoma?

Sachpekidis

Stein‐Thoeringer

Kopp‐Schneider

et al. 2023

Eur J Nucl Med Mol Imaging

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Aim The development of biomarkers that can reliably and early predict response to immune checkpoint inhibitors (ICIs) is crucial in melanoma. In recent years, the gut microbiome has emerged as an important regulator of immunotherapy response, which may, moreover, serve as a surrogate marker and prognosticator in oncological patients under immunotherapy. Aim of the present study is to investigate if physiologic colonic [18F]FDG uptake in PET/CT before start of ICIs correlates with clinical outcome of metastatic melanoma patients. The relation between [18F]FDG uptake in lymphoid cell-rich organs and long-term patient outcome is also assessed. Methodology One hundred nineteen stage IV melanoma patients scheduled for immunotherapy with ipilimumab, applied either as monotherapy or in combination with nivolumab, underwent baseline [18F]FDG PET/CT. PET/CT data analysis consisted of standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) calculations in the colon as well as measurements of the colon-to-liver SUV ratios (CLRmean, CLRmax). Visual grading of colon uptake based on a four-point scale was also performed. Moreover, the spleen-to-liver SUV ratios (SLRmean, SLRmax) and the bone marrow-to-liver SUV ratios (BLRmean, BLRmax) were calculated. We also measured serum lipopolysaccharide (LPS) levels as a marker for bacterial translocation and surrogate for mucosal defense homeostasis. The results were correlated with patients’ best clinical response, progression-free survival (PFS), and overall survival (OS) as well as clinical signs of colitis. Results Median follow-up [95%CI] from the beginning of immunotherapy was 64.6 months [61.0–68.6 months]. Best response to treatment was progressive disease (PD) for 60 patients, stable disease (SD) for 37 patients, partial response (PR) for 18 patients, and complete response (CR) for 4 patients. Kaplan–Meier curves demonstrated a trend for longer PFS and OS in patients with lower colonic SUV and CLR values; however, no statistical significance for these parameters as prognostic factors was demonstrated. On the other hand, patients showing disease control as best response to treatment (SD, PR, CR) had significantly lower colonic MTV and TLG than those showing PD. With regard to lymphoid cell-rich organs, significantly lower baseline SLRmax and BLRmax were observed in patients responding with disease control than progression to treatment. Furthermore, patients with lower SLRmax and BLRmax values had a significantly longer OS when dichotomized at their median. In multivariate analysis, PET parameters that were found to significantly adversely correlate with patient survival were colonic MTV for PFS, colonic TLG for PFS, and BLRmax for PFS and OS. Conclusions Physiologic colonic [18F]FDG uptake in PET/CT, as assessed by means of SUV, before start of ipilimumab-based treatment does not seem to independently predict patient survival of metastatic melanoma. On the other hand, volumetric PET parameters, such as MTV and TLG, derived from the normal gut may identify patients showing disease control to immunotherapy and significantly correlate with PFS. Moreover, the investigation of glucose metabolism in the spleen and the bone marrow may offer prognostic information.

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Rifaximin suppresses background intestinal 18F-FDG uptake on PET/CT scans

Abstract: This pilot study shows that treatment with rifaximin for 2 days before PET/CT scanning can significantly reduce physiological F-FDG uptake in the normal colonic lumen.

Cited by 14 publications

References 24 publications

Gut microbiota and physiologic bowel 18F-FDG uptake

Gut microbiota and physiologic bowel 18F-FDG uptake

Role of molecular imaging in the management of patients affected by inflammatory bowel disease: State-of-the-art

Can physiologic colonic [18F]FDG uptake in PET/CT imaging predict response to immunotherapy in metastatic melanoma?

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