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Observer variation study of the assessment and diagnosis of incidental colonic FDG uptake

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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.

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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.

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Authors and Affiliations

  1. Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjyuku-ku, Tokyo, 162-8655, Japan

    Ryogo Minamimoto & Miyako Morooka

  2. Screening Technology and Development Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan

    Takashi Terauchi

  3. Atsuchi Memorial Institute of Radiology, Atsuchi Memorial Clinic PET Center, Kagoshima, Japan

    Seishi Jinnouchi

  4. PET Imaging Center, Koga Hospital 21, Kurume, Japan

    Tsuyoshi Yoshida & Koichiro Kaneko

  5. Central CI Clinic, Sapporo, Japan

    Eriko Tsukamoto

  6. Department of Clinical Research and Informatics, National Center for Global Health and Medicine, Tokyo, Japan

    Takuro Shimbo

  7. Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan

    Kimiteru Ito

  8. Gaienhigashi Clinic, Tokyo, Japan

    Kimiichi Uno

  9. Department of Radiology, Saitama Medical Center, Saitama Medical School, Saitama, Japan

    Hitoshi Ohno

  10. Positron Imaging Center, Aizawa Hospital, Matsumoto, Japan

    Kazuhiro Oguchi

  11. Department of Diagnostic Radiology, Kofu Municipal Hospital, Kofu, Japan

    Satoshi Kato

  12. PET Center, Kofu Neurosurgical Hospital, Kofu, Japan

    Yoko Satoh

  13. Department of Radiology, East Nagoya Imaging Diagnosis Center, Nagoya, Japan

    Tsuneo Tamaki

  14. Department of Radiology, School of Medicine, Keio University, Tokyo, Japan

    Tadaki Nakahara

  15. Department of Radiology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan

    Ryogo Minamimoto & Tomio Inoue

  16. Division of Molecular Imaging, Institute of Biomedical Research and Innovation, Kobe, Japan

    Michio Senda

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  1. Ryogo Minamimoto
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  2. Takashi Terauchi
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Correspondence to Ryogo Minamimoto.

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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

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  • DOI: https://doi.org/10.1007/s12149-013-0712-x

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