Positron Emission Tomography in the Investigation of Pediatric Inflammatory Bowel Disease

Lemberg, Daniel A.; Issenman, Robert M.; Cawdron, Ruth; Green, Timothy; Mernagh, John R.; Skehan, Stephen J.; Nahmias, Claude; Jacobson, Kevan

doi:10.1097/01.mib.0000172810.49619.cb

Cited by 95 publications

(49 citation statements)

References 26 publications

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“…Several studies have suggested that 18 F-FDG PET and PET/CT in adult and pediatric patients, compared with standard endoscopy, histology, radiography, and small bowel imaging, are useful for identifying active IBD (15,(23)(24)(25)(26)(27)(28). Sensitivities for this purpose have been reported to range from 54% to 98%, with specificities from 55% to 81% (15,(23)(24)(25)(26)(27)(28).…”

Section: Discussionmentioning

confidence: 99%

“…Sensitivities for this purpose have been reported to range from 54% to 98%, with specificities from 55% to 81% (15,(23)(24)(25)(26)(27)(28). In general, these studies were limited because they did not provide a full evaluation of the entire bowel wall, and CD lesions are characteristically transmural.…”

Section: Discussionmentioning

confidence: 99%

“…Initial animal and human data suggest that the noninvasive imaging technique using 18 F-FDG and PET may help for identifying gastrointestinal inflammation (15,(23)(24)(25)(26)(27)(28). Combined PET/CT scanners offer more precise lesion characterization and localization (26,27).…”

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confidence: 99%

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Prediction of the Need for Surgical Intervention in Obstructive Crohn's Disease by ¹⁸F-FDG PET/CT

Jacene¹,

Ginsburg²,

Kwon³

et al. 2009

J Nucl Med

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We preoperatively determined the accuracy of 18 F-FDG PET/CT for differentiating fixed muscle hypertrophy and fibrotic stenoses from acute transmural inflammatory stenoses in patients with Crohn's disease (CD) scheduled to undergo surgical resection for obstructive symptoms. Methods: Seventeen patients with known CD prospectively underwent 18 F-FDG PET/CT before already-planned surgery for obstructive symptoms. Image interpretation was by consensus of 2 readers with knowledge of patient participation in the study but not of other clinical history. Lesions were qualitatively graded on a 5-point scale for the presence of increased 18 F-FDG uptake consistent with active inflammation. Maximum lean standardized uptake value (SUL max ) was determined for lesions scored 1 or more. Imaging results were compared with the pathologic grading of inflammation and predominant histopathologic subtype for each patient's surgical specimen, whether mainly inflammation, fibrosis, or muscle hypertrophy. Results: Thirteen of the 17 patients underwent surgery (median, 28 d after PET/CT; range, 2-148 d), and 12 of these 13 had histopathologic correlation. Despite the predominant histopathologic subtype (inflammation, 5; fibrosis, 4; and muscle hypertrophy, 3), acute and chronic inflammation, fibrosis (median, 50%; range, 40%290%), and muscle hypertrophy (median, 20-fold thickening; range, 9-to 40-fold thickening) were found in all patients. SUL max was significantly higher in severe than in mild-to-moderate chronic inflammation (8.2 6 2.8 vs. 4.7 6 2.5, P 5 0.04). No patient with predominantly fibrosis or muscle hypertrophy (n 5 7) had an SUL max greater than 8. Visually, 10 of 12 patients on PET/CT were considered to have active inflammation of the bowel. Conclusion: Patients with CD who undergo surgery for obstructive symptoms have histopathologically mixed findings of inflammation, fibrosis, and muscle hypertrophy. Qualitative PET interpretations were quite sensitive, but additional semiquantitative analyses using SUL max helped identify patients with active inflammation. This information may be beneficial for referring gastroenterologists considering medical therapy versus surgery for patients with CD who present with obstructive symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prediction of the Need for Surgical Intervention in Obstructive Crohn's Disease by ¹⁸F-FDG PET/CT

Jacene¹,

Ginsburg²,

Kwon³

et al. 2009

J Nucl Med

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“…However 18 FDG PET has some limits to detect detailed morphologic information therefore benefits of combined use of CT and MR enterography. 18 FDG-PET/ CT enterography (CTE) increases the sensitivity and specificity in the detection and monitoring of disease because provides morphological, physiological and metabolic information and may also allow distinction between active or fibrotic strictures [98] . [97] compared the measurement of disease activity with 18 F-FDG PET/CT with endoscopic biopsies and reported a sensitivity of 82% and specificity of 97%, using 18 F-FDG PET/CT and other studies have reported sensitivity of 85%-98% and specificity of 50%-89% [99101] .…”

Section: Indicationsmentioning

confidence: 99%

Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn’s disease

Masselli

Mastroiacovo

Marco

et al. 2016

WJR

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Crohn's disease affects more than 500000 individuals in the United States, and about 25% of cases are diagnosed during the pediatric period. Imaging of the bowel has undergone dramatic changes in the past two decades. The endoscopy with biopsy is generally considered the diagnostic reference standard, this combination can evaluates only the mucosa, not inflammation or fibrosis in the mucosa. Actually, the only modalities that can visualize submucosal tissues throughout the small bowel are the computed tomography (CT) enterography (CTE) with the magnetic resonance enterography (MRE). CT generally is highly utilized, but there is growing concern over ionizing radiation and cancer risk; it is a very important aspect to keep in consideration in pediatric patients. In contrast to CTE, MRE does not subject patients to ionizing radiation and can be used to detect detailed morphologic information and functional data of bowel disease, to monitor the effects of medical therapy more accurately, to detect residual active disease even in patients showing apparent clinical resolution and to guide treatment more accurately.

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“…Also if PET may not be able to replace conventional studies, these authors underlined that this functional method may be useful when conventional studies cannot be performed or fail to be completed (27).…”

Section: Fdg Pet and Petict In The Assessment Oflbd In Pediatric Patimentioning

confidence: 99%

The Role of Positron Emission Tomography in Inflammatory Bowel Disease

et al. 2012

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Inflammatory bowel diseases (IBD) are a group of pathological conditions characterized by chronic inflammation of the gastrointestinal tract, including Crohn's disease and ulcerative colitis. To date, imaging of IBD is based on several radiological techniques such as barium studies, magnetic resonance imaging, and computed tomography (CT). Endoscopy is the gold standard for the assessment of the large bowel and proximal small intestine in patients with IBD allowing the biopsy of the visualized bowel. Positron emission tomography (PET) and PET/CT with Fluorine-18-fluoro-2-deoxy-D-glucose (FDG) is a functional imaging method used to detect abnormalities in glucose metabolism in a variety of disorders. FDG accumulates mainly in tumours, but increased uptake and retention has been shown also in lesions with a high concentration of inflammatory cells, such as granulocytes and activated macrophages. Recent literature data demonstrate that FDG-PET and PET/CT may be useful noninvasive tools for identifying and localizing active IBD. In patients with an established diagnosis of IBD, FDG-PET and PET/CT may provide information about disease activity, location and extent of the disease within the intestinal tract, allowing early recognition of disease relapse and possible complications. Furthermore, these techniques may play a role in assessing the treatment response to medical therapy in patients with IBD.

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Positron Emission Tomography in the Investigation of Pediatric Inflammatory Bowel Disease

Abstract: This study suggests that PET offers a noninvasive tool for identifying and localizing active intestinal inflammation in children with IBD. PET may not be able to replace conventional studies; however, it may be useful when conventional studies cannot be performed or fail to be completed.

Cited by 95 publications

References 26 publications

Prediction of the Need for Surgical Intervention in Obstructive Crohn's Disease by ¹⁸F-FDG PET/CT

Prediction of the Need for Surgical Intervention in Obstructive Crohn's Disease by ¹⁸F-FDG PET/CT

Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn’s disease

The Role of Positron Emission Tomography in Inflammatory Bowel Disease

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Positron Emission Tomography in the Investigation of Pediatric Inflammatory Bowel Disease

Abstract: This study suggests that PET offers a noninvasive tool for identifying and localizing active intestinal inflammation in children with IBD. PET may not be able to replace conventional studies; however, it may be useful when conventional studies cannot be performed or fail to be completed.

Cited by 95 publications

References 26 publications

Prediction of the Need for Surgical Intervention in Obstructive Crohn's Disease by 18F-FDG PET/CT

Prediction of the Need for Surgical Intervention in Obstructive Crohn's Disease by 18F-FDG PET/CT

Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn’s disease

The Role of Positron Emission Tomography in Inflammatory Bowel Disease

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Product

Resources

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Prediction of the Need for Surgical Intervention in Obstructive Crohn's Disease by ¹⁸F-FDG PET/CT

Prediction of the Need for Surgical Intervention in Obstructive Crohn's Disease by ¹⁸F-FDG PET/CT