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Combined [18F]-Fluorodeoxyglucose Positron Emission Tomography-MR Imaging: A Promising Tool for Diagnostics of Small Bowel Crohn’s Disease

Year: 2024

Type: article

Abstract: INTRODUCTION: Diagnostics of small bowel Crohn's disease (CD) can be difficult. Combined positron emission tomography-magnetic resonance enterography (PET-MRE) can be used to evaluate intestinal metabolism, but clinical use has been limited due to accessibility, costs, absence of standardized methods, and diagnostic thresholds. Our aim was to show that combined PET-MRE can be used to diagnose active small bowel CD. METHODS: We performed a fusion PET-MRE scan with [18F]-FDG tracer to 30 patients with suspected small bowel CD in colonoscopy. Standardized uptake values (SUVs) were measured from small bowel. The diagnosis was confirmed with small bowel capsule endoscopy. Clinicians chose appropriate medication to each patient blinded from SUV results. Endoscopic, laboratory, and MRE findings were investigated in relation to SUV. RESULTS: Fusion PET-MRE outperformed MRE in diagnostic accuracy. Patients diagnosed with CD (N = 24) had higher SUV than patients not diagnosed with CD (N = 6) (3.34 vs. 1.84, p = 0.022). A diagnostic cut-off at SUV at 2.5 could be used (AUROC = 0.81). A higher SUV predicts need for immunosuppressive medication (p = 0.0026) and biologics (p = 0.0005). SUV correlates positively with Simple Endoscopic Score for Crohn's Disease (SES-CD), fecal calprotectin, and CRP and negatively with Hb and serum albumin. CONCLUSION: In future, [18F]-FDG PET-MRE can be used in diagnostics of small bowel CD as a safe alternative for capsule endoscopy. High SUV can predict a more progressive disease course and need for more advanced therapies. INTRODUCTION: Diagnostics of small bowel Crohn's disease (CD) can be difficult. Combined positron emission tomography-magnetic resonance enterography (PET-MRE) can be used to evaluate intestinal metabolism, but clinical use has been limited due to accessibility, costs, absence of standardized methods, and diagnostic thresholds. Our aim was to show that combined PET-MRE can be used to diagnose active small bowel CD. METHODS: We performed a fusion PET-MRE scan with [18F]-FDG tracer to 30 patients with suspected small bowel CD in colonoscopy. Standardized uptake values (SUVs) were measured from small bowel. The diagnosis was confirmed with small bowel capsule endoscopy. Clinicians chose appropriate medication to each patient blinded from SUV results. Endoscopic, laboratory, and MRE findings were investigated in relation to SUV. RESULTS: Fusion PET-MRE outperformed MRE in diagnostic accuracy. Patients diagnosed with CD (N = 24) had higher SUV than patients not diagnosed with CD (N = 6) (3.34 vs. 1.84, p = 0.022). A diagnostic cut-off at SUV at 2.5 could be used (AUROC = 0.81). A higher SUV predicts need for immunosuppressive medication (p = 0.0026) and biologics (p = 0.0005). SUV correlates positively with Simple Endoscopic Score for Crohn's Disease (SES-CD), fecal calprotectin, and CRP and negatively with Hb and serum albumin. CONCLUSION: In future, [18F]-FDG PET-MRE can be used in diagnostics of small bowel CD as a safe alternative for capsule endoscopy. High SUV can predict a more progressive disease course and need for more advanced therapies.

Source: Digestive Diseases

DOI: 10.1159/000542379

Authors: Juho Mattila, Johanna Kallio, Eliisa Löyttyniemi, Pirjo Nuutila, Jukka Koffert

Institutions: Turku University Hospital, University of Turku, Turku PET Centre

Language: English

Topic: Inflammatory Bowel Disease

Subfield: Genetics

Field: Biochemistry, Genetics and Molecular Biology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,060