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Incremental diagnostic utility of gastric distension FDG PET/CT

  • Pierre-Yves Le Roux
  • Cuong P. Duong
  • Carlos S. Cabalag
  • Bimal K. Parameswaran
  • Jason Callahan
  • Rodney J. Hicks
Original Article

Abstract

Purpose

To assess the diagnostic utility of gastric distension (GD) FDG PET/CT in both patients with known gastric malignancy and those not known to have gastric malignancy but with incidental focal FDG uptake in the stomach.

Methods

This retrospective analysis included 88 patients who underwent FDG PET/CT following GD with hyoscine N-butylbromide (Buscopan®) and water ingestion as part of routine clinical evaluation between 2004 and 2014. FDG PET/CT scans before and after GD were reported blinded to the patient clinical details in 49 patients undergoing pretreatment staging of gastric malignancy and 39 patients who underwent GD following incidental suspicious gastric uptake. The PET findings were validated by a composite clinical standard.

Results

In the 49 patients undergoing pretreatment staging of gastric malignancy, GD improved PET detection of the primary tumour (from 80 % to 90 %). PET evaluation of tumour extent was concordant with endoscopic/surgical reports in 31 % (interpreter 1) and 45 % (interpreter 2) using pre-GD images and 73 % and 76 % using GD images. Interobserver agreement also improved with GD (κ = 0.29 to 0.69). Metabolic and morphological quantitative analysis demonstrated a major impact of GD in normal gastric wall but no significant effect in tumour, except a minor increase in SUV related to a delayed acquisition time. The tumour to normal stomach SUVmax ratio increased from 3.8 ± 2.9 to 9.2 ± 8.6 (mean ± SD) with GD (p < 0.0001), facilitating detection and improved assessment of the primary tumour. In 25 (64 %) of the 39 patients with incidental suspicious gastric uptake, acquisition after GD correctly excluded a malignant process. In 10 (71 %) of the remaining 14 patients with persistent suspicious FDG uptake despite GD, malignancy was confirmed and in 3 (21 %) an active but benign pathology was diagnosed.

Conclusion

GD is a simple way to improve local staging with FDG PET in patients with gastric malignancy. In the setting of incidental suspicious gastric uptake, GD is also an effective tool for ruling out malignancy and leads to the avoidance of unnecessary endoscopy.

Keywords

FDG PET/CT Gastric cancer Staging Gastric distension Incidental finding 

Notes

Acknowledgments

We thank Elizabeth Drummond and Annette Hogg for developing and maintaining the PET database.

Compliance with ethical standards

Funding

Pierre-Yves Le Roux has received funding from the France-Australia Science Innovation Collaboration (FASIC) programme.

Conflicts of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

The requirement to obtain informed consent for this retrospective study was waived by the PMCC Ethics Committee (trial 14_151R).

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Pierre-Yves Le Roux
    • 1
    • 2
  • Cuong P. Duong
    • 3
  • Carlos S. Cabalag
    • 3
  • Bimal K. Parameswaran
    • 1
  • Jason Callahan
    • 1
  • Rodney J. Hicks
    • 1
    • 4
  1. 1.Peter MacCallum Cancer CentreDivision of Radiation Oncology and Cancer ImagingEast MelbourneAustralia
  2. 2.Department of Nuclear MedicineBrest University HospitalBrestFrance
  3. 3.Department of Surgical OncologyPeter MacCallum Cancer CentreEast MelbourneAustralia
  4. 4.The University of MelbourneParkvilleAustralia

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