Improving the detecting efficiency of suspected gastrointestinal tumors with dual-time-point 18F-FDG PET/CT

  • Jian-Hua Song
  • Jin-Hua Zhao
  • Xue-Qian Xie
  • Yan Xing
  • Xiang Chen
  • Wen-Li Qiao
  • Chang-Cun Liu
  • Tai-Song Wang


We conducted a retrospective analysis of 221 subjects with 256 suspected gastrointestinal lesions from 2007 to 2015 to explore the detecting efficiency of dual-time-point fluorine-18 fludeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and pathology examination. The abdominal delayed PET/CT was performed within 45 min of the conventional scan. The change in maximum standardized uptake value (ΔSUVmax) and morphological features of the suspected lesions between the conventional and dual-time-point PET/CT were compared. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of conventional PET/CT were 81.6% (84/103), 56.2% (86/153), 55.6% (84/151), and 81.9% (86/105), respectively. Those of dual-time-point PET/CT were 94.1% (97/103), 78.4% (120/153), 74.6% (97/130), and 95.2% (120/126), respectively. There was a significant difference between the conventional and dual-time-point PET/CT (P < 0.005). The SUVearly and the %ΔSUVmax could not present more information in differential diagnoses, but the rate of tumors with increased SUVdelay accounted for 79.6% (82/103) and more than that of nonneoplastic lesions (15.5%, 29/187) (x 2 = 115.5, P < 0.01). Therefore, the dual-time-point 18F-FDG PET/CT had a higher sensitivity and NPV than the conventional PET/CT to detect gastrointestinal tumors. The constant morphology and increased SUVdelay help to detect the tumors and adding delayed imaging on the locality will be an effective method when we accidentally find a suspected gastrointestinal tumor on the conventional PET/CT images.


18F-FDG PET/CT Gastrointestinal tumors Dual-time-point imaging 


  1. 1.
    J.H. Song, J.H. Zhao, X. Chen et al., Evaluation of the primary lesion detection in colorectal carcinoma with 18F-FDG PET-CT. Chin. J. Gastrointest. Surg. 12, 174–177 (2009). doi: 10.3760/cma.j.issn.1671-0274.2009.02.027. (in Chinese) Google Scholar
  2. 2.
    J. Czernin, M. Allen-Auerbach, H.R. Schelbert, Improvements in cancer staging with PET/CT: literature-based evidence as of September 2006. J. Nucl. Med. 48(suppl 1), 78S–88S (2007)Google Scholar
  3. 3.
    A. Toriihara, K. Yoshida, I. Umehara et al., Normal variants of bowel FDG uptake in dual-time-point PET/CT imaging. Ann. Nucl. Med. 25, 173–178 (2011). doi: 10.1007/s12149-010-0439-x CrossRefGoogle Scholar
  4. 4.
    X.J. Cui, N. Fang, Y.L. Wang et al., The effect of cleaning and retention enema on the diagnosis of locally hypermetabolic lesions in colorectum using 18F-FDG PET/CT. Acta Academiae Medicinae Qingdao Universitatis 45, 49–51 (2009). doi: 10.3969/j.issn.1672-4488.2009.01.018. (in Chinese) Google Scholar
  5. 5.
    P. Veit, C. Kühle, T. Beyer et al., Whole body positron emission tomography/computed tomography (PET/CT) tumour staging with integrated PET/CT colonography: technical feasibility and first experiences in patients with colorectal cancer. Gut 55, 68–73 (2006). doi: 10.1136/gut.2005.064170 CrossRefGoogle Scholar
  6. 6.
    H.B. Wu, Z.H. Huang, Q.S. Wang et al., Several methods for eliminating physiological accumulation of 18F-FDG in the stomach and intestine. Chin. J. Nucl. Med. 22, 235–236 (2002). doi: 10.3760/cma.j.issn.2095-2848.2002.04.017. (in Chinese) Google Scholar
  7. 7.
    L. Filippi, M. D’Arienzo, F. Scopinaro et al., Usefulness of dual-time point imaging after carbonated water for the fluorodeoxyglucose positron emission imaging of peritoneal carcinomatosis in colon cancer. Cancer Biother. Radiopharm. 28, 29–33 (2013). doi: 10.1089/cbr.2012.1179 CrossRefGoogle Scholar
  8. 8.
    H. Zhuang, M. Pourdehnad, E.S. Lambright et al., Dual time point 18F-FDG PET imaging for differentiating malignant from inflammatory processes. J. Nucl. Med. 42, 1412–1417 (2001)Google Scholar
  9. 9.
    A. Matthies, M. Hickeson, A. Cuchiara et al., Dual time point 18F-FDG PET for the evaluation of pulmonary nodules. J. Nucl. Med. 43, 871–875 (2002)Google Scholar
  10. 10.
    R. Kumar, V.A. Loving, A. Chauhan et al., Potential of dual-time-point imaging to improve breast cancer diagnosis with (18)F-FDG PET. J. Nucl. Med. 46, 1819–1824 (2005)Google Scholar
  11. 11.
    K.K. Miyake, Y. Nakamoto, K. Togashi, Dual-time-point 18F-FDG PET/CT in patients with colorectal cancer: clinical value of early delayed scanning. Ann. Nucl. Med. 26, 492–500 (2012). doi: 10.1007/s12149-012-0599-y CrossRefGoogle Scholar
  12. 12.
    J. Cui, P. Zhao, Z. Ren et al., Evaluation of dual time point imaging 18F-FDG PET/CT in differentiating malignancy from benign gastric disease. Medicine 94, e1356 (2015). doi: 10.1097/MD.0000000000001356 CrossRefGoogle Scholar
  13. 13.
    B.R. Weston, R.B. Lyer, W. Qiao et al., Ability of integrated positron emission and computed tomography to detect significant colonic pathology: the experience of a tertiary cancer center. Cancer 116, 1454–1461 (2010). doi: 10.1002/cncr.24885 CrossRefGoogle Scholar
  14. 14.
    E. Shmidt, V. Nehra, V. Lowe et al., Clinical significance of incidental [18F]FDG uptake in the gastrointestinal tract on PET/CT imaging: a retrospective cohort study. BMC Gastroenterol. 16, 125 (2016). doi: 10.1186/s12876-016-0545-x CrossRefGoogle Scholar
  15. 15.
    A. Zade, N. Purandare, V. Rangarajan et al., Role of delayed imaging to differentiate intense physiological 18F FDG uptake from peritoneal deposits in patients presenting with intestinal obstruction. Clin. Nucl. Med. 37, 783–785 (2012). doi: 10.1097/RLU.0b013e31824c5e7d CrossRefGoogle Scholar
  16. 16.
    Y.E. Huang, Y.J. Huang, M. Ko et al., Dual-time-point 18F-FDG PET/CT in the diagnosis of solitary pulmonary lesions in a region with endemic granulomatous diseases. Ann. Nucl. Med. 30, 652–658 (2016). doi: 10.1007/s12149-016-1109-4 CrossRefGoogle Scholar
  17. 17.
    D. Kadaria, D.S. Archie, I. SultanAli et al., Dual time point positron emission tomography/computed tomography scan in evaluation of intrathoracic lesions in an area endemic for histoplasmosis and with high prevalence of sarcoidosis. Am. J. Med. Sci. 346, 358–362 (2013). doi: 10.1097/MAJ.0b013e31827b9b6d CrossRefGoogle Scholar
  18. 18.
    D.G. Meng, X.G. Sun, G. Huang et al., Comparison of the effect of positive and negative oral contrast agents on delineation and 18F-FDG uptake of gastrointestinal tract. Chin. J. Nucl. Med. 30, 272–275 (2010). doi: 10.3760/cma.j.issn.0253-9780.2010.04.014. (in Chinese) Google Scholar
  19. 19.
    J.D. Soyka, K. Strobel, P. Veit-Haibach et al., Influence of bowel preparation before 18F-FDG PET/CT on physiologic 18F-FDG activity in the intestine. J. Nucl. Med. 51, 507–510 (2010). doi: 10.2967/jnumed.109.071001 CrossRefGoogle Scholar
  20. 20.
    S.B. Ahn, D.S. Han, J.H. Bae et al., The miss rate for colorectal adenoma determined by quality-adjusted, back-to-back colonoscopies. Gut Liver 6, 64–70 (2012). doi: 10.5009/gnl.2012.6.1.64 CrossRefGoogle Scholar

Copyright information

© Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Chinese Nuclear Society, Science Press China and Springer Nature Singapore Pte Ltd. 2017

Authors and Affiliations

  • Jian-Hua Song
    • 1
  • Jin-Hua Zhao
    • 1
  • Xue-Qian Xie
    • 2
  • Yan Xing
    • 1
  • Xiang Chen
    • 1
  • Wen-Li Qiao
    • 1
  • Chang-Cun Liu
    • 1
  • Tai-Song Wang
    • 1
  1. 1.Department of Nuclear Medicine, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
  2. 2.Department of Radiology, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina

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