Role of gastric distention with additional water in differentiating locally advanced gastric carcinomas from physiological uptake in the stomach on 18F-fluoro-2-deoxy-D-glucose PET

Abstract

Gastric distention as a result of patients drinking a glass of water is a simple and noninvasive method for improving the diagnostic accuracy of FDG-PET in patients with locally advanced gastric carcinoma.

Japanese Gastric Cancer Association Task Force for Research Promotion: clinical utility of 18F-fluoro-2-deoxyglucose positron emission tomography in gastric cancer. A systematic review of the literature

“…Furthermore, a significant difference in FDG uptake was observed among the three portions of the stomach: upper third [ middle third [ lower third; the physiological gastric FDG uptake was significantly higher at the oral end. Therefore, stronger gastric FDG uptake at the anal end would suggest pathological uptake [2,3].…”

“…To reduce non-specific FDG accumulation in the gastric mucosa, Kamimura et al [3] proposed that the patient should consume additional water to distend the stomach before PET examination. The mean SUVs in each portion of the stomach before and after the consumption of additional water were as follows: upper-third portion, 2.41 ± 0.75 versus 1.82 ± 0.66; middle-third portion, 2.28 ± 0.73 versus 1.73 ± 0.56; and lower-third portion, 1.61 ± 0.89 versus 1.48 ± 0.49, respectively.…”

“…This seems to be a simple, cost-effective method to improve the diagnostic accuracy of PET. Visual analysis with special attention to the configuration of FDG activity after water ingestion seems to be more useful than the change in SUV for the evaluation of remnant stomach [1,3,31]. De Potter et al [32] retrospectively assessed the accuracy of PET for diagnosing gastric cancer recurrence in 33 patients.…”

The Role of 2-[F-18] Fluoro 2-Deoxy D-Glucose Positron Emission Tomography in the Preoperative Staging of Gastric Cancer

“…Endoscopic mucosal resection or laparoscopic or open gastrectomy, in addition to limited lymph node dissection, is an adequate treatment method in EGC without N1 node involvement. The high specificity in the N1 group decreases the rate of unnecessary surgical resection [21][22][23].…”

“…An exploratory laparotomy is invasive and expensive, although it is the gold standard method for identifying peritoneal metastases [22,23]. The sensitivity and specificity of CT in identifying peritoneal metastasis and implants have been reported as 76.5% and 91.6%, respectively, while the specificity and sensitivity of FDG-PET have been reported as 98.9% and 35.3% [24,25].…”