Abstract
Purpose
The aim of this study was to evaluate the interpretations of incidental colonic 18F-FDG uptake made by 10 experienced readers and to more clearly identify the pattern of suspicious colonic FDG uptake. The potential contributions of delayed FDG-PET scanning and of immune fecal occult blood testing (FOBT) in making a diagnosis were also analyzed.
Materials and methods
Visual interpretations by 10 readers were made for 147 FDG uptake sites from 126 PET scans (cancer, 38 sites; adenoma, 43 sites; and no abnormality, 66 sites) with colonic FDG uptake. Assessments for the early FDG-PET images were (1) FDG uptake pattern, (2) FDG uptake degree, and (3) likelihood of malignancy. For the delayed images, the assessments were (1) change in the FDG uptake position, (2) change in FDG uptake degree, and (3) likelihood of malignancy. The results of FOBT were analyzed independently of the visual interpretations.
Results
Interobserver agreement (κ) was 0.501 for assessing FDG uptake patterns, while agreement on assessing changes in uptake degree and changes in uptake position between early and delayed imaging were low (κ = 0.213–0.229). Logistic regression analysis indicated that ‘FDG uptake patterns’ and ‘FDG uptake degree’ were significantly related to decide on the suspicion of malignancy (p < 0.001) and the final result (p < 0.001). “Small localized” and “large irregular localized” types had a high probability of a lesion regardless of either (1) FDG uptake degree or (2) variation in the uptake between the early and the delayed image. The delayed image decreased false-positive cases for some FDG uptake patterns, but it had little impact on distinguishing clearly between “cancer or adenoma” and “normal”. The addition of FOBT had little impact on the diagnosis.
Conclusion
There was highest agreement among readers with respect to the recognition of specified colonic FDG uptake patterns, and this pattern recognition had the most influence on the diagnosis. “Small localized” and “large irregular localized” types had a high probability of a lesion. The addition of delayed imaging and of FOBT results to the early imaging did not have much impact on the diagnosis.
Similar content being viewed by others
References
Prabhakar HB, Sahani DV, Fischman AJ, Mueller PR, Blake MA. Bowel hot spots at PET-CT. Radiographics. 2007;27:145–59.
Israel O, Yefremov N, Bar-Shalom R, Kagana O, Frenkel A, Keidar Z, et al. PET/CT detection of unexpected gastrointestinal foci of 18F-FDG uptake: incidence, localization patterns, and clinical significance. J Nucl Med. 2005;46:758–62.
Kamel EM, Thumshirn M, Truninger K, Schiesser M, Fried M, Padberg B, et al. Significance of incidental 18F-FDG accumulations in the gastrointestinal tract in PET/CT: correlation with endoscopic and histopathologic results. J Nucl Med. 2004;45:1804–10.
Lee JC, Hartnett GF, Hughes BG, Ravi Kumar AS. The segmental distribution and clinical significance of colorectal fluorodeoxyglucose uptake incidentally detected on PET-CT. Nucl Med Commun. 2009;30:333–7.
Drenth JP, Nagengast FM, Oyen WJ. Evaluation of (pre-) malignant colonic abnormalities: endoscopic validation of FDG-PET findings. Eur J Nucl Med. 2001;28:1766–9.
Agress H Jr, Cooper BZ. Detection of clinically unexpected malignant and premalignant tumors with whole-body FDG PET: histopathologic comparison. Radiology. 2004;230:417–22.
Gutman F, Alberini JL, Wartski M, Vilain D, Le Stanc E, Sarandi F, et al. Incidental colonic focal lesions detected by FDG PET/CT. AJR Am J Roentgenol. 2005;185:495–500.
Even-Sapir E, Lerman H, Gutman M, Lievshitz G, Zuriel L, Polliack A, et al. The presentation of malignant tumours and pre-malignant lesions incidentally found on PET-CT. Eur J Nucl MedMol Imaging. 2006;33:541–52.
Pandit-Taskar N, Schöder H, Gonen M, Larson SM, Yeung HW. Clinical significance of unexplained abnormal focal FDG uptake in the abdomen during whole-body PET. AJR Am J Roentgenol. 2004;183:1143–7.
Nakajo M, Jinnouchi S, Tashiro Y, Shirahama H, Sato E, Koriyama C, et al. Effect of clinicopathologic factors on visibility of colorectal polyps with FDG PET. AJR Am J Roentgenol. 2009;92:754–60.
Tatlidil R, Jadvar H, Bading JR, Conti PS. Incidental colonic fluorodeoxyglucose uptake: correlation with colonoscopic and histopathologic findings. Radiology. 2002;224:783–7.
Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.
Keyes JW Jr. SUV: standard uptake or silly useless value? J Nucl Med. 1995;36:1836–9.
Kim S, Chung JK, Kim BT, Kim SJ, Jeong JM, Lee DS, et al. Relationship between gastrointestinal F-18-fluorodeoxyglucose accumulation and gastrointestinal symptoms in whole-body PET. Clin Positron Imaging. 1999;2:273–80.
Bond JH. Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps. Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. 2000;95:3053–63.
Chen CD, Yen MF, Wang WM, Kim SJ, Jeong JM, Lee DS, et al. A case-cohort study for the disease natural history of adenoma–carcinoma and de novo carcinoma and surveillance of colon and rectum after polypectomy: implication for efficacy of colonoscopy. Br J Cancer. 2003;88:1866–73.
Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, et al. Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med. 1993;329:1977–81.
Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G, et al. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med. 2000;343:162–8.
Read TE, Read JD, Butterly LF. Importance of adenomas 5 mm or less in diameter that are detected by sigmoidoscopy. N Engl J Med. 1997;336:8–12.
Pickhardt PJ, Choi JR, Hwang I, Butler JA, Puckett ML, Hildebrandt HA, et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med. 2003;349:2191–200.
Chen YK, Kao CH, Liao AC, Shen YY, Su CT. Colorectal cancer screening in asymptomatic adults: the role of FDG PET scan. Anticancer Res. 2003;23:4357–61.
Yasuda S, Fujii H, Nakahara T, Nishiumi N, Takahashi W, Ide M, et al. 18F-FDG PET detection of colonic adenomas. J Nucl Med. 2001;42:989–92.
von Schulthess GK. Positron emission tomography versus positron emission tomography/computed tomography: from “unclear” to “new-clear” medicine. Mol Imaging Biol. 2004;6:183–7.
Kostakoglu L, Hardoff R, Mirtcheva R, Goldsmith SJ. PET-CT fusion imaging in differentiating physiologic from pathologic FDG uptake. Radiographics. 2004;24:1411–31.
Mandel JS, Church TR, Bond JH, Ederer F, Geisser MS, Mongin SJ, et al. The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med. 2000;343:1603–7.
Kronborg O, Fenger C, Olsen J, Jørgensen OD, Søndergaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348:1467–71.
Hardcastle JD, Chamberlain JO, Robinson MH, Moss SM, Amar SS, Balfour TW, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996;348:1472–7.
Kramer BS, Gohagan JK, Prorok PC, editors. Cancer screening. New York: Marcel Dekker; 1999. p. 143–93.
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.
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.
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.
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.
Zhuang H, Pourdehnad M, Lambright ES, Yamamoto AJ, Lanuti M, Li P, Mozley PD, et al. Dual time point 18F-FDG PET imaging for differentiating malignant from inflammatory processes. J Nucl Med. 2001;42:1412–7.
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.
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.
Toriihara A, Yoshida K, Umehara I, Shibuya H. Normal variants of bowel FDG uptake in dual-time-point PET/CT imaging. Ann Nucl Med. 2001;25:173–8.
Acknowledgments
This work was supported in part by the National Cancer Center Research and Development Fund 23-A-25. The authors thank Dr. Hirokazu Takahashi from Yokohama City University and Dr. Yoko Miyata from National Center for Global Health and Medicine for valuable advice toward this article. The authors also thank Hiromitsu Daisaki, Ph.D., for management and evaluation of this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Minamimoto, R., Terauchi, T., Jinnouchi, S. et al. Observer variation study of the assessment and diagnosis of incidental colonic FDG uptake. Ann Nucl Med 27, 468–477 (2013). https://doi.org/10.1007/s12149-013-0712-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12149-013-0712-x