Skip to main content
Top
Published in: Annals of Nuclear Medicine 3/2011

01-04-2011 | Original Article

Normal variants of bowel FDG uptake in dual-time-point PET/CT imaging

Authors: Akira Toriihara, Katsuya Yoshida, Isao Umehara, Hitoshi Shibuya

Published in: Annals of Nuclear Medicine | Issue 3/2011

Login to get access

Abstract

Objective

To evaluate the normal variants of the physiological bowel 2-deoxy-2-[18F]fluoro-d-glucose (FDG) uptake in dual-time-point positron emission tomography/computed tomography (PET/CT).

Methods

We performed a retrospective review of 206 consecutive asymptomatic subjects who underwent whole-body FDG PET/CT for medical checkup in our institution. The criteria for exclusion of the subjects from this study were as follows: history of abdominal surgeries or endoscopic mucosal resection, history of any malignant tumors, symptoms of diarrhea or constipation, a positive fecal occult blood test, elevated serum carcinoembryonic antigen (CEA) level, and hyperglycemia (more than 110 mg/dl). A total of 39 subjects (32 males, 7 females, mean age 58.1 years old) were enrolled in this retrospective study. Two radiologists evaluated the dual-time-point FDG PET/CT images of these 39 subjects, retrospectively. FDG uptakes in 5 areas (small bowel (SB), cecum and ascending colon (AC), transverse colon (TC), descending colon (DC), and rectosigmoid colon (RS)) were scored visually in comparison with the activity in the liver (0 = no uptake, 1 = activity less than that in the liver, and 2 = activity equal to or greater than that in the liver) in the early and delayed image. The scores decided by two radiologists were averaged and this average score was defined as the bowel uptake score (BUS). For 34 areas with the BUS of 2 in either the early or delayed images, the maximum standardized uptake values (SUVmax) were measured for semiquantitative analysis. Wilcoxon’s signed rank test and paired t test were adopted for the statistical analyses.

Results

The average BUS in the early/delayed images was 1.19/1.17 (SB), 0.81/1.23 (AC), 0.10/0.35 (TC), 0.35/0.59 (DC), and 1.17/1.54 (RS), respectively. The average SUVmax of the 34 areas with a score of 2 was 3.11 in the early images and 3.76 in the delayed images. The scores in the AC, TC, DC and RS, and the SUVmax were significantly higher in the delayed images (p < 0.05).

Conclusions

Physiological FDG uptake in the colon increases significantly from the early to the delayed phase in dual-time-point PET/CT imaging, which should be carefully taken into consideration in the diagnosis of bowel diseases.
Literature
1.
go back to reference Abouzied MM, Crawford ES, Nabi HA. 18F-FDG imaging: pitfalls and artifacts. J Nucl Med Technol. 2005;33:145–55.PubMed Abouzied MM, Crawford ES, Nabi HA. 18F-FDG imaging: pitfalls and artifacts. J Nucl Med Technol. 2005;33:145–55.PubMed
2.
go back to reference Shreve P, Bui CDH. Artifacts and normal variants in FDG PET. In: Wahl RL, editor. Principles and practice of PET and PET/CT. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, a Wolters Kluwer business; 2009. p.139–68. Shreve P, Bui CDH. Artifacts and normal variants in FDG PET. In: Wahl RL, editor. Principles and practice of PET and PET/CT. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, a Wolters Kluwer business; 2009. p.139–68.
3.
go back to reference Prabhakar HB, Sahani DV, Fischman AF, Mueller PR, Blake MA. Bowel hot spots at PET-CT. RadioGraphics. 2007;27:145–59.PubMedCrossRef Prabhakar HB, Sahani DV, Fischman AF, Mueller PR, Blake MA. Bowel hot spots at PET-CT. RadioGraphics. 2007;27:145–59.PubMedCrossRef
4.
go back to reference Tatlidil R, Jadvar H, Bading JR, Conti PS. Incidental colonic fluorodeoxyglucose uptake: correlation with colonoscopic and histopathologic findings. Radiology. 2002;224:783–7.PubMedCrossRef Tatlidil R, Jadvar H, Bading JR, Conti PS. Incidental colonic fluorodeoxyglucose uptake: correlation with colonoscopic and histopathologic findings. Radiology. 2002;224:783–7.PubMedCrossRef
5.
go back to reference Gutman F, Alberini JL, Wartski M, Vilain D, Le Stanc E, Sarandi F, et al. Incidental colonic focal lesions detected by FDG PET/CT. Am J Roentgenol. 2005;185:495–500.CrossRef Gutman F, Alberini JL, Wartski M, Vilain D, Le Stanc E, Sarandi F, et al. Incidental colonic focal lesions detected by FDG PET/CT. Am J Roentgenol. 2005;185:495–500.CrossRef
6.
go back to reference Otsuka H, Graham MM, Kubo A, Nishitani H. The effect of oral contrast on large bowel activity in FDG-PET/CT. Ann Nucl Med. 2005;19:101–8.PubMedCrossRef Otsuka H, Graham MM, Kubo A, Nishitani H. The effect of oral contrast on large bowel activity in FDG-PET/CT. Ann Nucl Med. 2005;19:101–8.PubMedCrossRef
7.
go back to reference Blake MA, Setty BN, Cronin CG, Kalra M, Holalkere NS, Fischman AJ, et al. Evaluation of the effects of oral water and low-density barium sulphate suspension on bowel appearance on FDG-PET/CT. Eur Radiol. 2010;20:157–64.PubMedCrossRef Blake MA, Setty BN, Cronin CG, Kalra M, Holalkere NS, Fischman AJ, et al. Evaluation of the effects of oral water and low-density barium sulphate suspension on bowel appearance on FDG-PET/CT. Eur Radiol. 2010;20:157–64.PubMedCrossRef
8.
go back to reference Soyka JD, Strobel K, Veit-Haibach P, Schaefer NG, Schmid DT, Tschopp A, et al. Influence of bowel preparation before 18F-FDG PET/CT on physiologic 18F-FDG activity in the intestine. J Nucl Med. 2010;51:507–10.PubMedCrossRef Soyka JD, Strobel K, Veit-Haibach P, Schaefer NG, Schmid DT, Tschopp A, et al. Influence of bowel preparation before 18F-FDG PET/CT on physiologic 18F-FDG activity in the intestine. J Nucl Med. 2010;51:507–10.PubMedCrossRef
9.
go back to reference Emmott J, Sanghera B, Chambers J, Wong WL. The effects of N-butylscopolamine on bowel uptake: an 18F-FDG PET study. Nucl Med Commun. 2008;29:11–6.PubMedCrossRef Emmott J, Sanghera B, Chambers J, Wong WL. The effects of N-butylscopolamine on bowel uptake: an 18F-FDG PET study. Nucl Med Commun. 2008;29:11–6.PubMedCrossRef
10.
go back to reference Murphy R, Doerger KM, Nathan MA, Lowe VJ. Pretreatment with diphenoxylate hydrochloride/atropine sulphate (lomotil) does not decrease physiologic bowel FDG activity on PET/CT scans of the abdomen and pelvis. Mol Imaging Biol. 2009;11:114–7.PubMedCrossRef Murphy R, Doerger KM, Nathan MA, Lowe VJ. Pretreatment with diphenoxylate hydrochloride/atropine sulphate (lomotil) does not decrease physiologic bowel FDG activity on PET/CT scans of the abdomen and pelvis. Mol Imaging Biol. 2009;11:114–7.PubMedCrossRef
11.
go back to reference Kubota K, Itoh M, Ozaki K, Ono S, Tashiro M, Yamaguchi K, et al. Advantage of delayed whole-body FDG-PET imaging for tumour detection. Eur J Nucl Med. 2001;28:696–703.PubMedCrossRef Kubota K, Itoh M, Ozaki K, Ono S, Tashiro M, Yamaguchi K, et al. Advantage of delayed whole-body FDG-PET imaging for tumour detection. Eur J Nucl Med. 2001;28:696–703.PubMedCrossRef
12.
go back to reference Hustinx R, Smith RJ, Benard F, Rosenthal DI, Machtay M, Farber LA, et al. Dual time point fluorine-18 fluorodeoxyglucose positron emission tomography: a potential method to differentiate malignancy from inflammation and normal tissue in the head and neck. Eur J Nucl Med. 1999;26:1345–8.PubMedCrossRef Hustinx R, Smith RJ, Benard F, Rosenthal DI, Machtay M, Farber LA, et al. Dual time point fluorine-18 fluorodeoxyglucose positron emission tomography: a potential method to differentiate malignancy from inflammation and normal tissue in the head and neck. Eur J Nucl Med. 1999;26:1345–8.PubMedCrossRef
13.
go back to reference Matthies A, Hickeson M, Cuchiara A, Alavi A. Dual time point 18F-FDG PET for the evaluation of pulmonary nodules. J Nucl Med. 2002;43:871–5.PubMed Matthies A, Hickeson M, Cuchiara A, Alavi A. Dual time point 18F-FDG PET for the evaluation of pulmonary nodules. J Nucl Med. 2002;43:871–5.PubMed
14.
go back to reference Boerner AR, Weckesser M, Herzog H, Schmitz T, Audretsch W, Nitz U, et al. Optimal scan time for fluorine-18 fluorodeoxyglucose positron emission tomography in breast cancer. Eur J Nucl Med. 1999;26:226–30.PubMedCrossRef Boerner AR, Weckesser M, Herzog H, Schmitz T, Audretsch W, Nitz U, et al. Optimal scan time for fluorine-18 fluorodeoxyglucose positron emission tomography in breast cancer. Eur J Nucl Med. 1999;26:226–30.PubMedCrossRef
15.
go back to reference Kumar R, Loving VA, Chauhan A, Zhuang H, Mitchell S, Alavi A. Potential of dual-time-point imaging to improve breast cancer diagnosis with 18F-FDG PET. J Nucl Med. 2005;46:1819–24.PubMed Kumar R, Loving VA, Chauhan A, Zhuang H, Mitchell S, Alavi A. Potential of dual-time-point imaging to improve breast cancer diagnosis with 18F-FDG PET. J Nucl Med. 2005;46:1819–24.PubMed
16.
go back to reference Nakamoto Y, Higashi T, Sakahara H, Tamaki N, Kogire M, Doi R, et al. Delayed 18F-fluoro-2-deoxy-d-glucose positron emission tomography scan for differentiation between malignant and benign lesions in the pancreas. Cancer. 2000;89:2547–54.PubMedCrossRef Nakamoto Y, Higashi T, Sakahara H, Tamaki N, Kogire M, Doi R, et al. Delayed 18F-fluoro-2-deoxy-d-glucose positron emission tomography scan for differentiation between malignant and benign lesions in the pancreas. Cancer. 2000;89:2547–54.PubMedCrossRef
17.
go back to reference Lodge MA, Lucas JD, Marsden PK, Cronin BF, O’Doherty MJ, Smith MA. A PET study of 18FDG uptake in soft tissue masses. Eur J Nucl Med. 1999;26:22–30.PubMedCrossRef Lodge MA, Lucas JD, Marsden PK, Cronin BF, O’Doherty MJ, Smith MA. A PET study of 18FDG uptake in soft tissue masses. Eur J Nucl Med. 1999;26:22–30.PubMedCrossRef
18.
go back to reference Zhuang H, Pourdehnad M, Lambright ES, Yamamoto AJ, Lanuti M, Li P, et al. Dual time point 18F-FDG PET imaging for differentiating malignant from inflammatory processes. J Nucl Med. 2001;42:1412–7.PubMed Zhuang H, Pourdehnad M, Lambright ES, Yamamoto AJ, Lanuti M, Li P, et al. Dual time point 18F-FDG PET imaging for differentiating malignant from inflammatory processes. J Nucl Med. 2001;42:1412–7.PubMed
19.
go back to reference Gontier E, Fourme E, Wartski M, Blondet C, Bonardel G, Le Stanc E, et al. High and typical 18F-FDG bowel uptake in patients treated with metformin. Eur J Nucl Med Mol Imaging. 2008;35:95–9.PubMedCrossRef Gontier E, Fourme E, Wartski M, Blondet C, Bonardel G, Le Stanc E, et al. High and typical 18F-FDG bowel uptake in patients treated with metformin. Eur J Nucl Med Mol Imaging. 2008;35:95–9.PubMedCrossRef
Metadata
Title
Normal variants of bowel FDG uptake in dual-time-point PET/CT imaging
Authors
Akira Toriihara
Katsuya Yoshida
Isao Umehara
Hitoshi Shibuya
Publication date
01-04-2011
Publisher
Springer Japan
Published in
Annals of Nuclear Medicine / Issue 3/2011
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-010-0439-x

Other articles of this Issue 3/2011

Annals of Nuclear Medicine 3/2011 Go to the issue