Skip to main content

Advertisement

SpringerLink
Log in

18F-Fluorodeoxyglucose Positron-Emission Tomography (PET) Can Be Used to Assess Inflammation Non-invasively in Crohn’s Disease

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Differential therapy requires repeated diagnostic assessment for mapping and monitoring of disease activity in Crohn’s disease (CD).

Purpose

The purpose of this prospective study was to evaluate the accuracy of 18F-fluorodexyglucose positron-emission tomography (FDG-PET) for non-invasive assessment of disease activity in CD.

Methods

Forty-three patients with CD underwent ileocolonoscopy and hydromagnetic resonance imaging (hydro-MRI) as reference standards. In addition, FDG-PET was performed and correlated with clinical data, hydro-MRI, and endoscopy findings. Diagnostic accuracy was determined for all methods.

Results

Two-hundred and forty-one bowel segments could be analyzed by all methods. Of 80 endoscopically inflamed segments in CD, FDG-PET detected 72 and hydro-MRI 53 segments. Overall sensitivity was 90 % (FDG-PET) versus 66 % (hydro-MRI), and specificity was 92.6 % versus 99 %. In the proximal ileum, hydro-MRI revealed inflammation in eight out of 49 patients and FDG-PET, also, detected all of these inflamed segments. Seventeen stenoses could be identified in 43 CD patients. With regard to assessment as inflammatory or fibrotic stenosis, there was good concordance between colonoscopy, hydro-MRI, and FDG-PET. In one case only, the nature of the stenosis was assessed differently. In contrast with leukocyte numbers and CDAI, there was significant correlation of FDG-PET activity with C-reactive protein and CDEIS levels (P = 0.019 and P = 0.007, respectively).

Conclusion

FDG-PET is able to detect mucosal inflammation in CD with high sensitivity and specificity and to enable proper assessment of inflammatory activity in stenoses. FDG-PET is, thus, a promising non-invasive technique for clinical management of CD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Fireman Z, Mahajna E, Broide E, et al. Diagnosing small bowel Crohn’s disease with wireless capsule endoscopy. Gut. 2003;52:390–392.

    Article  PubMed  CAS  Google Scholar 

  2. Voderholzer WA, Beinhoelzl J, Rogalla P, et al. Small bowel involvement in Crohn’s disease: a prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis. Gut. 2005;54:369–373.

    Article  PubMed  CAS  Google Scholar 

  3. Voderholzer WA, Ortner M, Rogalla P, Beinholzl J, Lochs H. Diagnostic yield of wireless capsule enteroscopy in comparison with computed tomography enteroclysis. Endoscopy. 2003;35:1009–1014.

    Article  PubMed  CAS  Google Scholar 

  4. Sinha R, Murphy P, Hawker P, Sanders S, Rajesh A, Verma R. Role of MRI in Crohn’s disease. Clin Radiol. 2009;64:341–352.

    Article  PubMed  CAS  Google Scholar 

  5. Schunk K, Kern A, Heussel CP, et al. Assessment of inflammatory activity in Crohn disease with hydro-MRI. Rofo. 2000;172:153–160.

    Article  PubMed  CAS  Google Scholar 

  6. Rimola J, Rodriguez S, Garcia-Bosch O, et al. Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn’s disease. Gut. 2009;58:1113–1120.

    Article  PubMed  CAS  Google Scholar 

  7. Rieber A, Wruk D, Nussle K, et al. MRI of the abdomen combined with enteroclysis in Crohn disease using oral and intravenous Gd-DTPA. Radiologe. 1998;38:23–28.

    Article  PubMed  CAS  Google Scholar 

  8. Albert JG, Martiny F, Krummenerl A, et al. Diagnosis of small bowel Crohn’s disease: a prospective comparison of capsule endoscopy with magnetic resonance imaging and fluoroscopic enteroclysis. Gut. 2005;54:1721–1727.

    Article  PubMed  CAS  Google Scholar 

  9. Horsthuis K, Lavini Mphil C, Stoker J. MRI in Crohn’s disease. J Magn Reson Imaging. 2005;22:1–12.

    Article  PubMed  Google Scholar 

  10. Schreyer AG, Rath HC, Kikinis R, et al. Comparison of magnetic resonance imaging colonography with conventional colonoscopy for the assessment of intestinal inflammation in patients with inflammatory bowel disease: a feasibility study. Gut. 2005;54:250–256.

    Article  PubMed  CAS  Google Scholar 

  11. Lee JK, Marcos HB, Semelka RC. MR imaging of the small bowel using the HASTE sequence. AJR Am J Roentgenol. 1998;170:1457–1463.

    Article  PubMed  CAS  Google Scholar 

  12. Siddiki HA, Fidler JL, Fletcher JG, et al. Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn’s disease. AJR Am J Roentgenol. 2009;193:113–121.

    Article  PubMed  Google Scholar 

  13. Kubota K. From tumor biology to clinical Pet: a review of positron-emission tomography (PET) in oncology. Ann Nucl Med. 2001;15:471–486.

    Article  PubMed  CAS  Google Scholar 

  14. Kumar R, Alavi A. Clinical applications of fluorodeoxyglucose–positron-emission tomography in the management of malignant melanoma. Curr Opin Oncol. 2005;17:154–159.

    Article  PubMed  Google Scholar 

  15. Hellwig D, Baum RP, Kirsch C. FDG-PET, PET/CT and conventional nuclear medicine procedures in the evaluation of lung cancer: a systematic review. Nuklearmedizin. 2009;48:59–69. (quiz N8-9).

    PubMed  CAS  Google Scholar 

  16. Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology. 2004;126:1504–1517.

    Article  PubMed  Google Scholar 

  17. de Geus-Oei LF, Vriens D, van Laarhoven HW, van der Graaf WT, Oyen WJ. Monitoring and predicting response to therapy with 18F-FDG PET in colorectal cancer: a systematic review. J Nucl Med. 2009;50:43S–54S.

    Article  PubMed  Google Scholar 

  18. van der Bruggen W, Bleeker-Rovers CP, Boerman OC, Gotthardt M, Oyen WJ. PET and SPECT in osteomyelitis and prosthetic bone and joint infections: a systematic review. Semin Nucl Med. 2010;40:3–15.

    Article  PubMed  Google Scholar 

  19. Bartenstein P, Weindl A, Spiegel S, et al. Central motor processing in Huntington’s disease. A PET study. Brain. 1997;120:1553–1567.

    Article  PubMed  Google Scholar 

  20. El-Haddad G, Zhuang H, Gupta N, Alavi A. Evolving role of positron-emission tomography in the management of patients with inflammatory and other benign disorders. Semin Nucl Med. 2004;34:313–329.

    Article  PubMed  Google Scholar 

  21. De Winter F, Vogelaers D, Gemmel F, Dierckx RA. Promising role of 18F-fluoro-D-deoxyglucose positron-emission tomography in clinical infectious diseases. Eur J Clin Microbiol Infect Dis. 2002;21:247–257.

    Article  PubMed  Google Scholar 

  22. Lemberg DA, Issenman RM, Cawdron R, et al. Positron-emission tomography in the investigation of pediatric inflammatory bowel disease. Inflamm Bowel Dis. 2005;11:733–738.

    Article  PubMed  Google Scholar 

  23. Louis E, Ancion G, Colard A, Spote V, Belaiche J, Hustinx R. Noninvasive assessment of Crohn’s disease intestinal lesions with (18)F-FDG PET/CT. J Nucl Med. 2007;48:1053–1059.

    Article  PubMed  Google Scholar 

  24. Meisner RS, Spier BJ, Einarsson S, et al. Pilot study using PET/CT as a novel, noninvasive assessment of disease activity in inflammatory bowel disease. Inflamm Bowel Dis. 2007;13:993–1000.

    Article  PubMed  Google Scholar 

  25. Rubin DT, Surma BL, Gavzy SJ, et al. Positron-emission tomography (PET) used to image subclinical inflammation associated with ulcerative colitis (UC) in remission. Inflamm Bowel Dis. 2009;15:750–755.

    Article  PubMed  Google Scholar 

  26. Neurath MF, Vehling D, Schunk K, et al. Noninvasive assessment of Crohn’s disease activity: a comparison of 18F-fluorodeoxyglucose positron-emission tomography, hydromagnetic resonance imaging, and granulocyte scintigraphy with labeled antibodies. Am J Gastroenterol. 2002;97:1978–1985.

    Article  PubMed  CAS  Google Scholar 

  27. Best WR, Becktel JM, Singleton JW, Kern F Jr. Development of a Crohn’s disease activity index. National Cooperative Crohn’s Disease Study. Gastroenterology. 1976;70:439–444.

    PubMed  CAS  Google Scholar 

  28. Mary JY, Modigliani R. Development and validation of an endoscopic index of the severity for Crohn’s disease: a prospective multicentre study. Groupe d’Etudes Therapeutiques des Affections Inflammatoires du Tube Digestif (GETAID). Gut. 1989;30:983–989.

    Article  PubMed  CAS  Google Scholar 

  29. Spier BJ, Perlman SB, Jaskowiak CJ, Reichelderfer M. PET/CT in the evaluation of inflammatory bowel disease: studies in patients before and after treatment. Mol Imaging Biol. 2010;12:85–88.

    Article  PubMed  Google Scholar 

  30. Spier BJ, Perlman SB, Jaskowiak CJ, Reichelderfer M. PET/CT in the evaluation of inflammatory bowel disease: studies in patients before and after treatment. Mol Imaging Biol. 2009;12:85–88.

    Article  PubMed  Google Scholar 

  31. Jacene HA, Ginsburg P, Kwon J, et al. Prediction of the need for surgical intervention in obstructive Crohn’s disease by 18F-FDG PET/CT. J Nucl Med. 2009;50:1751–1759.

    Article  PubMed  CAS  Google Scholar 

  32. Monteleone I, Pallone F, Monteleone G. Interleukin-23 and Th17 cells in the control of gut inflammation. Mediators Inflamm. 2009;2009:297645.

    Article  PubMed  Google Scholar 

  33. Rovedatti L, Kudo T, Biancheri P, et al. Differential regulation of interleukin 17 and interferon gamma production in inflammatory bowel disease. Gut. 2009;58:1629–1636.

    Article  PubMed  CAS  Google Scholar 

  34. Neurath MF, Finotto S. Translating inflammatory bowel disease research into clinical medicine. Immunity. 2009;31:357–361.

    Article  PubMed  CAS  Google Scholar 

  35. Ferrante M, D’Haens G, Rutgeerts P, Vermeire S, Van Assche G. Optimizing biologic therapies for inflammatory bowel disease (ulcerative colitis and Crohn’s disease). Curr Gastroenterol Rep. 2009;11:504–508.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The study has been conducted without any direct or indirect public or private funding.

Conflict of interest

The authors deny any conflicting interests.

Author information

Authors and Affiliations

  1. 1st Department of Medicine, Johannes Gutenberg-University, 55131 Mainz, Langenbeckstrasse 1, Mainz, Germany

    Martin H. Holtmann, Manuela Uenzen, Martin Goetz, Peter R. Galle & Markus F. Neurath

  2. Department of Nuclear Medicine, Johannes Gutenberg-University, Mainz, Germany

    Andreas Helisch, Mathias Schreckenberger & Peter Bartenstein

  3. Department of Radiology, Johannes Gutenberg-University, Mainz, Germany

    Anja Dahmen

  4. I. Medical Clinic, University of Erlangen-Nuremberg, Erlangen, Germany

    Jonas Mudter

  5. Department of Nuclear Medicine, Klinikum Großhadern, Munich, Germany

    Peter Bartenstein

Authors
  1. Martin H. Holtmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Manuela Uenzen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andreas Helisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anja Dahmen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jonas Mudter
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Martin Goetz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mathias Schreckenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Peter R. Galle
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Peter Bartenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Markus F. Neurath
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin H. Holtmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Holtmann, M.H., Uenzen, M., Helisch, A. et al. 18F-Fluorodeoxyglucose Positron-Emission Tomography (PET) Can Be Used to Assess Inflammation Non-invasively in Crohn’s Disease. Dig Dis Sci 57, 2658–2668 (2012). https://doi.org/10.1007/s10620-012-2190-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-012-2190-8

Keywords

Search

Navigation