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The Role of Gastric Distention in Differentiating Recurrent Tumor from Physiologic Uptake in the Remnant Stomach on 18F-FDG PET

Authors
 Mijin Yun  ;  Hyun Seok Choi  ;  Eunhye Yoo  ;  Jung Kyun Bong  ;  Young Hoon Ryu  ;  Jong Doo Lee 
Citation
 JOURNAL OF NUCLEAR MEDICINE, Vol.46(6) : 953-957, 2005 
Journal Title
 JOURNAL OF NUCLEAR MEDICINE 
ISSN
 0161-5505 
Issue Date
2005
MeSH
Adenocarcinoma/diagnosis* ; Adenocarcinoma/diagnostic imaging ; Adenocarcinoma/metabolism ; Adult ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; False Positive Reactions ; Female ; Fluorine Radioisotopes/pharmacokinetics ; Fluorodeoxyglucose F18*/pharmacokinetics ; Gastrectomy ; Gastric Stump/diagnostic imaging* ; Gastric Stump/physiopathology ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/diagnosis* ; Neoplasm Recurrence, Local/diagnostic imaging ; Neoplasm Recurrence, Local/metabolism ; Positron-Emission Tomography ; Radiopharmaceuticals*/pharmacokinetics ; Stomach Neoplasms/diagnosis* ; Stomach Neoplasms/diagnostic imaging ; Stomach Neoplasms/metabolism ; Whole-Body Counting
Keywords
15937305
Abstract
Physiologic (18)F-FDG uptake in the stomach can often cause false-positive results and lowers the usefulness of (18)F-FDG PET in evaluating the remnant stomach. We assessed the role of gastric distension to see whether it is beneficial for the differentiation of recurrent tumors from physiologic (18)F-FDG uptake in the remnant stomach. METHODS: Thirty patients (22 men and 8 women; age range, 27-80 y; mean age, 58.3 y) with a history of subtotal gastrectomy for gastric cancer underwent (18)F-FDG PET for various clinical indications. After whole-body imaging, the patients were asked to drink water, and then spot imaging of the stomach was performed. (18)F-FDG uptake in the remnant stomach was considered positive for malignancy if it was persistently increased, whether focal or diffuse, after water ingestion. We used 2 standardized uptake value (SUV) criteria to differentiate benign from malignant uptake. First, a lesion was considered benign if its SUV was less than 2 on whole-body imaging. Second, for a lesion with an SUV of 2 or above, it was classified as benign if SUV decreased by more than 10% after water ingestion. RESULTS: Visual analysis of whole-body images produced 9 true-negative, 4 false-positive, 16 true-positive, and 1 false-negative results. Use of additional spot images produced 12 true-negative, 1 false-positive, 15 true-positive, and 2 false-negative results. When an SUV cutoff of 2 was applied for malignancy before water ingestion, all 17 patients with local recurrence were correctly identified, but 11 of the 13 patients without local recurrence were falsely considered to have a recurrent tumor in the remnant stomach. To reduce the false-positive results, we used the second SUV criterion after water ingestion. Use of that criterion produced 4 false-negative results although it correctly identified the 11 false-positive results as true negative. CONCLUSION: Gastric distension by having patients drink a glass of water seems to be a simple, cost-effective way of improving the diagnostic accuracy of (18)F-FDG PET in patients with suspected recurrence in the remnant stomach. Visual analysis with special attention to the configuration of (18)F-FDG activity after water ingestion seems to be more useful than the change in SUV in evaluating the remnant stomach.
Files in This Item:
T200500027.pdf Download
DOI
OAK-2005-02359
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
Yonsei Authors
Ryu, Young Hoon(유영훈) ORCID logo https://orcid.org/0000-0002-9000-5563
Yun, Mi Jin(윤미진) ORCID logo https://orcid.org/0000-0002-1712-163X
Lee, Jong Doo(이종두)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/147286
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