IV. Positron Emission Tomography Imaging and the GI Tract
Advances in positron emission tomography imaging for the GI tract☆

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Technique

PET-FDG imaging is performed with the subject in a fasting state of at least 6 hours, because of the competitive inhibition of FDG uptake in tumor by endogenous glucose.3, 15, 16, 17, 18 Because hyperglycemia may considerably decrease FDG uptake in human tumors, a serum glucose level is routinely obtained before FDG administration, and the test is delayed in patients with glucose level over 200 mg/dL. After the intravenous administration of 370 to 740 MBq (10-20 mCi) F-18 FDG, PET-FDG scans are

General

The incidence of esophageal cancer has been increasing in the United States since the mid-1970s. More recently, adenocarcinoma of the esophagus has shown significant increase in incidence relative to squamous cell carcinoma.30, 31 In 1995, approximately 12,000 new cases of esophageal cancer were diagnosed in the United States, with an overall 5-year survival rate of 8% to 20%. More than 10,000 of the 12,000 newly diagnosed patients were expected to die of their disease and the majority died

Gastric carcinoma

Adenocarcinoma of the gastric cardia is also increasing but to a lesser extent than esophageal carcinoma.31 The limited published experience on gastric carcinomas suggests that PET is highly sensitive for identifying the primary tumor and distant metastases2, 38 as well as assessing response to neoadjuvant therapy.47

General

Advanced adenocarcinoma of the pancreas has a poor prognosis, and unfortunately, most patients with pancreatic carcinoma are not identified until it is unresectable for cure. Early diagnosis and surgical resection is the only potential curative treatment.16, 17, 26 The 5-year survival rate in newly diagnosed patients is 3%. If pancreaticoduodenectomy is performed, the 5-year survival rate increases to greater than 20% and there is an associated 2% to 3% mortality in patients who are carefully

General

In the United States, approximately 129,400 new cases of colorectal carcinoma were diagnosed in 1999. With an estimate of 56,600 of those cases resulting in death, this makes colorectal cancer the third most common cause of cancer mortality in the United States.53 At the time of initial presentation, only 36% of patients have localized colorectal carcinoma, whereas 39% have regional lymph node metastases and 19% have distant metastases. The overall 5-year survival rate after resection is 55% to

Hepatobiliary tumors

Three patterns of FDG accumulation in liver cancers have been identified: increased, similar, or decreased accumulation comparable with the background liver. Okazumi et al.,67 using kinetics analysis, performed a study and found that 55% of hepatocellular carcinoma (HCC) and all cases of cholangiocarcinomas and hepatic metastases demonstrated higher FDG uptake than normal liver. Similar or decreased FDG accumulation compared with liver was discovered only in type 2 and 3 HCC. In a study of 100

Summary

Conventional imaging modalities are considered in many institutions to be the initial method of choice for the workup of GI diseases, because of their cost-effectiveness and ease of performance. Before the emergence of clinical whole-body PET, the diagnostic workup for staging and restaging of patients with GI tract malignancies consisted of anatomic imaging modalities such as CT, US, and colonoscopy. These techniques are limited in their ability to discriminate reliably between malignant tumor

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      Citation Excerpt :

      These results further support the limitation of FDG-PET in detecting small-volume disease or the extent of hepatic metastatic accurately. Other studies confirm that FDG-PET has poor sensitivity for detecting small lesions (<1 cm in diameter) and inability to discriminate between lesions close to one another [20,28,31,32]. Rohren et al [33], in comparing FDG-PET scan with surgical inspection and intraoperative ultrasound, found that only 79% of hepatic metastatic lesions were identified by PET scan and detection directly correlated to size of the lesions.

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    ☆

    Reprint requests to: Kelly H. Pham, DO, UCSF Medical Center, 505 Parnassus Ave, San Francisco, CA 94122

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    Copyright © 2002 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.