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FDG-PET–CT Enterography Helps Determine Clinical Significance of Suspected Ileocecal Thickening: A Prospective Study

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Abstract

Background

Ileocecal thickening (ICT) on imaging could result from diverse etiologies but may also be clinically insignificant.

Aim

Evaluation of role of combined 2-deoxy-2-fluorine-18-fluoro-d-glucose(18F-FDG)-positron emission tomography and computed tomographic enterography (PET–CTE) for determination of clinical significance of suspected ICT.

Methods

This prospective study enrolled consecutive patients with suspected ICT on ultrasound. Patients were evaluated with PET–CTE and colonoscopy. The patients were divided into: Group A (clinically significant diagnosis) or Group B (clinically insignificant diagnosis) and compared for various clinical and radiological findings. The two groups were compared for maximum standardized uptake values of terminal ileum, ileo-cecal valve, cecum and overall.

Results

Of 34 patients included (23 males, mean age: 40.44 ± 15.40 years), 12 (35.3%) had intestinal tuberculosis, 11 (32.4%) Crohn’s disease, 3 (8.8%) other infections, 1 (2.9%) malignancy, 4 (11.8%) non-specific terminal ileitis while 3 (8.8%) had normal colonoscopy and histology. The maximum standardized uptake value of the ileocecal area overall (SUVmax-ICT-overall) was significantly higher in Group A (7.16 ± 4.38) when compared to Group B (3.62 ± 9.50, P = 0.003). A cut-off of 4.50 for SUVmax-ICT-overall had a sensitivity of 70.37% and a specificity of 100% for prediction of clinically significant diagnosis. Using decision tree model, the SUVmax-ICT with a cut-off of 4.75 was considered appropriate for initial decision followed by the presence of mural thickening in the next node.

Conclusion

PET–CTE can help in discrimination of clinically significant and insignificant diagnosis. It may help guide the need for colonoscopy in patients suspected to have ICT on CT.

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Authors and Affiliations

  1. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Abhi K. Singh, Shubhra Mishra, Harshal S. Mandavdhare, Kaushal K. Prasad, Usha Dutta & Vishal Sharma

  2. Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Rajender Kumar

  3. Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Pankaj Gupta

  4. Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Praveen Kumar-M

  5. Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Harjeet Singh

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  1. Abhi K. Singh
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Contributions

AKS was involved in data collection and analysis and manuscript approval. RKB was involved in data interpretation, revision and approval of manuscript. PG involved in data interpretation, revision and approval of manuscript. PKM involved in statistical analysis and revision and approval of manuscript. SM involved in manuscript writing, revision and approval of manuscript. HSM involved in provision of study material, revision and approval of manuscript. Harjeet Singh involved in provision of study material, revision and approval of manuscript. Kaushal K Prasad involved in data interpretation, revision and approval of manuscript. Usha Dutta involved in provision of study material, revision and approval of manuscript. VS involved in conception, data collection, provision of study material, manuscript draft, revision and approval of the manuscript.

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Correspondence to Vishal Sharma.

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Singh, A.K., Kumar, R., Gupta, P. et al. FDG-PET–CT Enterography Helps Determine Clinical Significance of Suspected Ileocecal Thickening: A Prospective Study. Dig Dis Sci 66, 1620–1630 (2021). https://doi.org/10.1007/s10620-020-06361-9

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