Imaging of Chronic Inflammatory Bowel Disease with 18F-FDG PET in Children and Adolescents

Abstract

Background:

Standard for diagnosis of inflammatory bowel disease (IBD) is the endoscopy of the stomach and the intestine. Aim of this study was to determine the value of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in pediatric patients with mild to moderate IBD.

Patients:

We included 23 children and adolescents between 8 and 17 years (median 15 years, 13 boys, 10 girls) in this retrospective study in a routine clinical setting. Diagnoses were Crohn’s disease in 19 and ulcerative colitis in 4 cases.

Methods:

3 children had a conventional FDG-PET, 20 patients a combined FDG-PET-computed tomography exam. All children had upper and lower intestinal endoscopy with biopsy and a Hydro-MRI exam to assess the jejunum and proximal ileum. The gastrointestinal tract was divided in 7 segments: Stomach plus duodenum, jejunum and proximal ileum, terminal ileum, cecum plus ascending colon, transverse colon, descending colon, and rectosigmoid.

Results:

Superficial gastric lesions were missed, gastric ulcerations were detected. For the stomach, the sensitivity was 0.25, the specificity was 1.00, the positive predictive value was 1.00, for the lower intestine (terminal ileum and colon) the values were 0.74, 0.88, and 0.96; for the terminal ileum 0.89, 0.75 and 0.94, respectively.

Discussion:

The sensitivity and specificity for of ileal and colonic lesions is high. FDG-PET has to be discussed as a tool for the determination of extent and degree of inflammation, especially in those parts of the small bowel that are not accessible to endoscopy. This has to be weighed against the additional radiation exposure administrated.

Zusammenfassung

Hintergrund:

Die Diagnose von chronisch-entzündlichen Darmerkrankungen (CED) wird durch die Endoskopie des Magens und Darmes gestellt. Ziel dieser Untersuchung war es, den Wert der 18-Fluor-Desoxyglucose-Positronen­emissionstomografie (FDG-PET) bei pädiatrischen Patienten mit milder bis moderater CED zu bestimmen.

Patienten:

In einer retrospektiven Studie wurden 23 Kinder und Jungendliche zwischen 8 und 17 Jahren (Median 15 Jahre, 13 Jungen, 10 Mädchen) aus der klinischen Routine eingeschlossen. 19 Patienten waren am Morbus Crohn erkrankt, 4 an Colitis ulcerosa.

Methoden:

3 Kinder wurden mit einer FDG-PET untersucht, 20 hatten eine kombinierte FDG-PET-Computertomografieuntersuchung. Alle Kinder wurden gastroskopiert und koloskopiert, die Diagnosen wurden bioptisch bestätigt. Zusätz­lich wurde eine Kernspintomografie des Darmes durchgeführt. Der Magendarmtrakt wurde in 7 Segmente eingeteilt: Magen und Duodenum, Jejunum und proximales Ileum, terminales Ileum, Coecum, Colon ascendens, Colon transversum, Colon descendens und Rektosigmoideum.

Diskussion:

Die Sensitivität und Spezifität für die unteren Darmabschnitte war hoch. FDG-PET sollte als eine Methode zur Bestimmung des Ausmaßes und der Schwere einer Manifestation der Erkrankung diskutiert werden; besonders bei der Beurteilung der Dünndarmabschnitte, die nicht der konventionellen Endoskopie zugänglich sind. Die zusätzliche Strahlenexposition durch die Untersuchung ist dabei zu berücksichtigen.

Key words

inflammatory bowel disease - children and adolescents - positron emission ­tomography - small bowel imaging

Schlüsselwörter

Chronisch-entzündliche Darmerkrankungen - Kinder und Jugendliche - Positronenemissions­tomografie - Dünndarmbildgebung

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