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 Table of Contents     
LETTER TO EDITOR
Year : 2011  |  Volume : 26  |  Issue : 4  |  Page : 211  

Importance of diffuse versus focal F-18 fluoro-deoxy-glucose uptake in oesophagus


1 Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
3 Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication1-Feb-2013

Correspondence Address:
Bhagwant Rai Mittal
Department of Nuclear Medicine and PET, PGIMER, Chandigarh- 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.106721

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How to cite this article:
Santhosh S, Mittal BR, Bhattacharya A, Das A, Kochhar R. Importance of diffuse versus focal F-18 fluoro-deoxy-glucose uptake in oesophagus. Indian J Nucl Med 2011;26:211

How to cite this URL:
Santhosh S, Mittal BR, Bhattacharya A, Das A, Kochhar R. Importance of diffuse versus focal F-18 fluoro-deoxy-glucose uptake in oesophagus. Indian J Nucl Med [serial online] 2011 [cited 2019 Dec 8];26:211. Available from: http://www.ijnm.in/text.asp?2011/26/4/211/106721

Sir,

A 60-year-old female patient presented with progressive dysphagia for solids for the past 18 months. The patient did not have any history of reflux symptoms or history of corrosive intake. Barium swallow study showed long segment narrowing involving the thoracic oesophagus. Contrast enhanced computed tomography showed smooth circumferential mural thickening. Positron emission tomography/computed tomography (PET/CT) was performed to look for any evidence of malignancy. Intense fluoro-deoxy-glucose (FDG) uptake was seen throughout the entire length of the thoracic oesophagus [Figure 1]a-d. Though FDG uptake was intense, benign pathology was suspected based on the diffuse uptake pattern. An upper gastrointestinal endoscopy (UGIE) showed inflamed hyperaemic indurated mucosa at about 20 cm and non-negotiable narrowing at 23 cm from the incisor. Biopsy revealed acute on chronic inflammation [Figure 1]e and f confirming benign pathology. The patient was then managed conservatively and was healthy until 1 year of follow-up.
Figure 1: F-18 FDG PET/CT images Sagittal CT (a), PET (b), fused PET/CT (c) and MIP PET image (d) showing intense diffuse FDG uptake along the thickened thoracic esophagus. Eosin-Hematoxylin stained fragments (e and f) show acute and chronic inflammatory cells with abundant plasma cells along with extensive vascular proliferation, fibrin and hemorrhage

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The oesophagus is usually not avid for FDG. Inflammation can mimic oesophageal malignancy. FDG uptake in the oesophagus has been reported in benign pathologies. [1],[2],[3] Combined focality-eccentricity score defined by Roedl, et al, [4] may help in the interpretation of non-specific oesophageal uptake on PET/CT examinations and could assist in making the decision of referring to endoscopy. Candidial esophagitis masquerading esophageal cancer has been reported. [5] Endoscopy has the highest malignancy yield when FDG uptake is focal and/or eccentric. FDG-PET, hence, could guide the biopsy site. Even though the FDG uptake was intense, the diffuse pattern of uptake in our case, directed the diagnosis towards a benign condition. The pattern of FDG uptake could guide while reporting FDG-PET/CT of patients with a suspicion of malignant oesophageal stricture.

 
   References Top

1.Kamel EM, Thumshirn M, Truninger K, Schiesser M, Fried M, Padberg B, et al. Significance of incidental 18F-FDG accumulations in the gastrointestinal tract in PET/CT: Correlation with endoscopic and histopathologic results. J Nucl Med 2004;45:1804-10.  Back to cited text no. 1
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2.Bakheet SM, Amin T, Alia AG, Kuzo R, Powe J. F-18 FDG uptake in benign esophageal disease. Clin Nucl Med 1999;24:995-7.  Back to cited text no. 2
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3.Bural GG, Kumar R, Mavi A, Alavi A. Reflux esophagitis secondary to chemotherapy detected by serial FDG-PET. Clin Nucl Med 2005;30:182-3.  Back to cited text no. 3
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4.Roedl JB, Colen RR, King K, Fischman AJ, Mueller PR, Blake MA. Visual PET/CT scoring for nonspecific 18F-FDG uptake in the differentiation of early malignant and benign esophageal lesions. AJR Am J Roentgenol 2008;191:515-21.  Back to cited text no. 4
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5.Shrikanthan S, Aydin A, Dhurairaj T, Alavi A, Zhuang H. Intense esophageal FDG activity caused by Candida infection obscured the concurrent primary esophageal cancer on PET imaging. Clin Nucl Med 2005;30:695-7.  Back to cited text no. 5
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