18F-FDG uptake in the stomach on screening PET/CT: value for predicting Helicobacter pylori infection and chronic atrophic gastritis

Abstract

BackgroundThe aim of this study was to determine the value of 18F-FDG uptake on screening PET/CT images for the prediction of Helicobacter pylori (H. pylori) infection and chronic atrophic gastritis.MethodsAmong subjects who underwent 18F-FDG PET/CT for cancer screening from April 2005 to November 2015, PET/CT images were analyzed in 88 subjects who had gastrointestinal fiberscopy within 6 months. The volumes of interest (VOIs) were placed in the fornix, corpus and antrum of the stomach to determine maximal standardized uptake value (SUVmax) and mean SUV (SUVmean). Receiver operating characteristic curve (ROC) analysis was performed to determine the diagnostic performance of SUV indicators in predicting H. pylori infection and chronic atrophic gastritis.ResultsSUV indicators of the stomach were significantly higher in subjects with H. pylori infection than those without (from P < 0.001 to P < 0.05). ROC analysis revealed that SUVmean had the highest performance in predicting H. pylori infection (AUC 0.807) and chronic atrophic gastritis (AUC 0.784). SUVmean exhibited the sensitivity of 86.5 % and the specificity of 70.6 % in predicting H. pylori infection, and the sensitivity of 75.0 % and 78.6 % in predicting chronic atrophic gastritis.ConclusionAssessment of 18F-FDG uptake in the stomach reflecting active inflammation is useful in predicting patients with H. pylori infection and subsequent chronic atrophic gastritis which is closely associated with the risk of gastric neoplasms.

Staging FDG PET-CT changes management in patients with gastric adenocarcinoma who are eligible for radical treatment

“…This is not a function of smaller tumour size as the average size of 18F-FDG negative tumours is close to 4 cm, with the smallest tumour measuring 1 cm. Additionally, physiological or inflammatory uptake in non-malignant gastric mucosa, for example, induced by Helicobacter pylori infection, can obscure a gastric cancer and provide difficulty with primary tumour identification [35]. Furthermore, more than half of the FDG PET-CT scans reported incidental findings, leading to additional tests and MDT discussion, which resulted in delays to treatment.…”

Gross Tumor Delineation in Esophageal Cancer on MRI Compared With 18F-FDG-PET/CT

“…Delineation on CT only is challenging, mainly in differentiating tumor from normal tissue at the cranial and caudal tumor borders. Delineation on FDG-PET/CT may help in determining these tumor borders; however, FDG uptake does not differentiate between tumor and inflammation, which can be difficult especially in tumors involving the GEJ 35, 36. Furthermore, on FDG-PET/CT the target volume can depend on the threshold chosen and may increase or decrease depending on the windowing.…”

Changes of 18F‐fluoro‐2‐deoxyglucose position‐emission tomography findings by the eradication of Helicobacter pylori in the stomach

“…Stomach physiologically accumulates FDG especially in the fundus and body but scarce in the antrum 8 . Although HP infection has been reported to show higher SUV compared with non‐HP‐infected stomach on the FDG‐PET, non‐HP‐infected stomach occasionally accumulates FDG 4‐9 . The accumulation of FDG in the fundic gland region was caused by fundic redness but not the other change such as erosion or hematin 6 …”

“…8 Although HP infection has been reported to show higher SUV compared with non-HP-infected stomach on the FDG-PET, non-HP-infected stomach occasionally accumulates FDG. [4][5][6][7][8][9] The accumulation of FDG in the fundic gland region was caused by fundic redness but not the other change such as erosion or hematin. 6 HP eradication could improve the mucosal atrophy in the long term 14 but the time course depends on the atrophic degree and duration of the HP infection.…”

“…Not only malignancy but also inflammatory change accumulates FDG such as vasculitis, sarcoidosis, autoimmune disease, and so on. 3 Regarding stomach, Helicobacter pylori (HP) infection and relating atrophic gastritis have been reported to increase the FDG uptake [4][5][6][7][8][9] but the changes of FDG uptake after HP eradication have never been reported. Health examination using FDG-PET to detect cancers is recently performed in Japan 10 but its efficacy to improve the prognosis of the cancer patients is still controversial.…”