Incidental focal colorectal 18F-fluorodeoxyglucose uptake on positron emission tomography/computed tomography |
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Authors: | Soung Hoon Cho Sang Woo Kim Won Chul Kim Jae Myung Park Division of Gastroenterology |
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Affiliation: | , Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 137-701, South Korea Ie Ryung Yoo, Sung Hoon Kim, Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 137-701, South Korea Seong Taek Oh, Department of Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 137-701, South Korea |
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Abstract: | AIM: To assess the clinical significance of incidental focal colorectal 18F-fluorodeoxyglucose (18F-FDG) uptake on 18F-FDG-positron emission tomography/computed tomography (PET/CT).METHODS: The records of all the cases which had undergone colonoscopy after PET/CT within a two weeks interval were reviewed. Adenomas were considered advanced when they were villous, ≥ 10 mm in size, or had high-grade dysplasia. Colorectal cancers and advanced adenomas are collectively referred to as advanced colorectal neoplasms. Receiver-operating characteristic curve analysis was used to determine the significant predictive maximum standardized uptake value (SUVmax) cutoff value for advanced colorectal neoplasms and cancer.RESULTS: Ninety-five colorectal lesions matched the site of incidental focal colorectal 18F-FDG uptake on PET/CT and 146 did not. Colonoscopy showed advanced colorectal neoplasms corresponding to the site of 18F-FDG uptake in 49 of the 95 (51.5%) lesions with incidental uptake. Of the lesions without incidental uptake, only 6 of 146 (4.1%) had advanced colorectal neoplasms on colonoscopy, indicating a statistically significant difference between the two groups (P < 0.001). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of incidental focal 18F-FDG uptake in identifying advanced colorectal neoplasms were 89.1%, 75.3%, 51.6%, 95.9%, and 78.4%, respectively. In detecting only CRC, these values were 89.2%, 69.6%, 34.7%, 97.3%, and 72.6%, respectively. The significant SUVmax cutoff value for advanced colorectal neoplasms (area under the curve 0.755, P < 0.001) was 4.35, with a sensitivity, specificity, PPV, NPV, and accuracy of 75.5%, 65.2%, 69.8%, 71.4% and 70.5%, respectively. For CRC, 5.05 was the significant SUVmax cutoff value (area under the curve 0.817, P < 0.001), with a sensitivity, specificity, PPV, NPV, and accuracy of 84.8%, 71.0%, 80.9%, 89.8%, and 75.8%, respectively.CONCLUSION: The presence of incidental focal colorectal 18F-FDG uptake on PET/CT with a SUVmax ≥ 4.35 increases the likelihood of an advanced colorectal neoplasm. |
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Keywords: | Positron emission tomography Adenomas Computed tomography Colorectal cancer Colonoscopy |
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