Prediction of the need for surgical intervention in obstructive Crohn's disease by18F-FDG PET/CT

Heather A. Jacene, Philip Ginsburg, John Kwon, Geoffrey C. Nguyen, Elizabeth A. Montgomery, Theodore M. Bayless, Richard L. Wahl

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

We preoperatively determined the accuracy of 18F-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 18F-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 18F-FDG uptake consistent with active inflammation. Maximum lean standardized uptake value (SULmax) was determined for lesions scored 1 or more. Imaging results were compared with the pathologic grading of inflammation and pre-dominant 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. SULmax was significantly higher in severe than in mild-to-moderate chronic inflammation (8.2 ± 2.8 vs. 4.7 ± 2.5, P = 0.04). No patient with predominantly fibrosis or muscle hypertrophy (n = 7) had an SULmax 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 SULmax 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.

Original languageEnglish (US)
Pages (from-to)1751-1759
Number of pages9
JournalJournal of Nuclear Medicine
Volume50
Issue number11
DOIs
StatePublished - Nov 1 2009

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Crohn Disease
Inflammation
Hypertrophy
Fibrosis
Muscles
Fluorodeoxyglucose F18
Pathologic Constriction
Patient Participation

Keywords

  • F-FDG
  • Crohn's disease
  • Inflammation
  • PET/CT
  • Stricture

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Jacene, H. A., Ginsburg, P., Kwon, J., Nguyen, G. C., Montgomery, E. A., Bayless, T. M., & Wahl, R. L. (2009). Prediction of the need for surgical intervention in obstructive Crohn's disease by18F-FDG PET/CT. Journal of Nuclear Medicine, 50(11), 1751-1759. https://doi.org/10.2967/jnumed.109.065466

Prediction of the need for surgical intervention in obstructive Crohn's disease by18F-FDG PET/CT. / Jacene, Heather A.; Ginsburg, Philip; Kwon, John; Nguyen, Geoffrey C.; Montgomery, Elizabeth A.; Bayless, Theodore M.; Wahl, Richard L.

In: Journal of Nuclear Medicine, Vol. 50, No. 11, 01.11.2009, p. 1751-1759.

Research output: Contribution to journalArticle

Jacene, HA, Ginsburg, P, Kwon, J, Nguyen, GC, Montgomery, EA, Bayless, TM & Wahl, RL 2009, 'Prediction of the need for surgical intervention in obstructive Crohn's disease by18F-FDG PET/CT', Journal of Nuclear Medicine, vol. 50, no. 11, pp. 1751-1759. https://doi.org/10.2967/jnumed.109.065466
Jacene, Heather A. ; Ginsburg, Philip ; Kwon, John ; Nguyen, Geoffrey C. ; Montgomery, Elizabeth A. ; Bayless, Theodore M. ; Wahl, Richard L. / Prediction of the need for surgical intervention in obstructive Crohn's disease by18F-FDG PET/CT. In: Journal of Nuclear Medicine. 2009 ; Vol. 50, No. 11. pp. 1751-1759.
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abstract = "We preoperatively determined the accuracy of 18F-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 18F-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 18F-FDG uptake consistent with active inflammation. Maximum lean standardized uptake value (SULmax) was determined for lesions scored 1 or more. Imaging results were compared with the pathologic grading of inflammation and pre-dominant 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. SULmax was significantly higher in severe than in mild-to-moderate chronic inflammation (8.2 ± 2.8 vs. 4.7 ± 2.5, P = 0.04). No patient with predominantly fibrosis or muscle hypertrophy (n = 7) had an SULmax 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 SULmax 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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AU - Bayless, Theodore M.

AU - Wahl, Richard L.

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N2 - We preoperatively determined the accuracy of 18F-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 18F-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 18F-FDG uptake consistent with active inflammation. Maximum lean standardized uptake value (SULmax) was determined for lesions scored 1 or more. Imaging results were compared with the pathologic grading of inflammation and pre-dominant 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. SULmax was significantly higher in severe than in mild-to-moderate chronic inflammation (8.2 ± 2.8 vs. 4.7 ± 2.5, P = 0.04). No patient with predominantly fibrosis or muscle hypertrophy (n = 7) had an SULmax 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 SULmax 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.

AB - We preoperatively determined the accuracy of 18F-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 18F-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 18F-FDG uptake consistent with active inflammation. Maximum lean standardized uptake value (SULmax) was determined for lesions scored 1 or more. Imaging results were compared with the pathologic grading of inflammation and pre-dominant 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. SULmax was significantly higher in severe than in mild-to-moderate chronic inflammation (8.2 ± 2.8 vs. 4.7 ± 2.5, P = 0.04). No patient with predominantly fibrosis or muscle hypertrophy (n = 7) had an SULmax 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 SULmax 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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KW - Crohn's disease

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KW - Stricture

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