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Incidental Colonic Focal Lesions Detected by FDG PET/CT

¹ Department of Nuclear Medicine, Rene Huguenin Cancer Research Center, 35 Rue Dailly, Saint-Cloud, France 92210.
² Department of Nuclear Medicine, Henri Becquerel Cancer Research Center, Rouen, France.
³ Department of Nuclear Medicine, Hospital Foch, Suresnes, France.

Abstract

OBJECTIVE. The aim of this study was to assess the performance of FDG PET/CT for the detection of colonic lesions, especially advanced neoplasms (villous or >10-mm adenomas, carcinomas). Because of ¹⁸F FDG accumulation in adenomatous polyps, PET using FDG can detect early premalignant colorectal lesions.

MATERIALS AND METHODS. FDG PET/CT studies performed for a 1-year period in 1,716 consecutive patients with various malignant diseases, except colorectal cancer, were retrospectively reviewed. PET images obtained 1 hr after FDG injection and noncontrast CT images used for attenuation correction were fused for analysis. Of 45 patients showing intense focal colonic FDG uptake, 20 patients (with 21 foci) underwent a colonoscopic investigation, and, when necessary, polyp resection. The intensity of FDG uptake was quantified using the standardized uptake value (SUV_max).

RESULTS. The FDG colonic foci were associated with 18 colonoscopic abnormalities in 15 patients, with no colonic abnormality detected in five patients (false-positive [FP] results). Histopathologic findings revealed advanced neoplasms in 13 patients (13 villous adenomas and three carcinomas) and two cases of hyperplastic polyps. A difference in the mean SUV_max was found between FP and true-positive colonic FDG foci but was not statistically significant (p = 0.14).

CONCLUSION. Presence of a focal colonic FDG uptake incidental finding on a PET/CT scan justifies a colonoscopy to detect (pre-)malignant lesions. The fusion of PET and CT images allows an accurate localization of the lesions. PET/CT is a useful tool to differentiate pathologic from physiologic FDG uptake.

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