Report from SNM: PET/CT helps monitor status of Crohn’s disease

Results from a Belgian study suggest that PET/CT should help supplement endoscopy for assessing the clinical status of Crohn's disease, an inflammatory bowel disease that affects up to two million people in the U.S., mainly young adults.

The trial, presented Monday at the 2007 Society of Nuclear Medicine meeting in Washington, DC, found that FDG-PET/CT accurately tracks the nature, frequency, intensity of Crohn's disease, according to lead investigator Dr. Roland Hustinx, head of nuclear medicine at the University Hospital of Liège. As disease status changes, proper therapy must be adjusted.

"PET/CT can answer the major question: What is the activity of the disease?" he said.

In a prospective trial involving 22 Crohn's disease patients, PET/CT detected 100% of the deep ulcers and strictures characteristic of severe endoscopic lesions. Noncontrast CT was most useful for localizing the lesions. Although severe type 3 and 4 endoscopic lesions were more frequently located in segments with bowel thickening, logistic regression analysis revealed that only the segment SUVmax analysis of FDG uptake was significantly associated with the lesions (p = 0.0002).

Overall, FDG-PET/CT detected 35 of 48 endoscopically affected segments for a sensitivity rate of 72.9%.

Patients will probably welcome PET/CT in place of gold standard ileocolonoscopy for monitoring Crohn's disease. The endoscopic exam surveying the large bowel and ileum is costly and can be physically unpleasant, Hustinx said. PET/CT is relatively simple, fast, and free of side effects.

Hustinx recommends PET/CT to screen Crohn's disease patients who require ileocolonoscopy.

"If the PET/CT is positive, the doctor should confirm the results using endoscopy. If the PET/CT is negative, there would be no need for the endoscopy, given the high negative predictive value of the technique," he said.

For more information from the Diagnostic Imaging archives:

Report from ECR: Hardware, software advances give fMRI a place in abdominal imaging

CT beats fluoroscopy for Crohn's disease

MR contributes to evaluation of pediatric Crohn's disease