title: 18F-Fluorodeoxyglucose positron-emission tomography (PET) can be used to assess inflammation non-invasively in Crohn's disease.
abstract: BACKGROUND
  Differential therapy requires repeated diagnostic assessment for mapping and monitoring of disease activity in Crohn's disease (CD).
  
  
  OBJECTIVE
  The purpose of this prospective study was to evaluate the accuracy of (18)F-fluorodexyglucose positron-emission tomography (FDG-PET) for non-invasive assessment of disease activity in CD.
  
  
  METHODS
  Forty-three patients with CD underwent ileocolonoscopy and hydromagnetic resonance imaging (hydro-MRI) as reference standards. In addition, FDG-PET was performed and correlated with clinical data, hydro-MRI, and endoscopy findings. Diagnostic accuracy was determined for all methods.
  
  
  RESULTS
  Two-hundred and forty-one bowel segments could be analyzed by all methods. Of 80 endoscopically inflamed segments in CD, FDG-PET detected 72 and hydro-MRI 53 segments. Overall sensitivity was 90 % (FDG-PET) versus 66 % (hydro-MRI), and specificity was 92.6 % versus 99 %. In the proximal ileum, hydro-MRI revealed inflammation in eight out of 49 patients and FDG-PET, also, detected all of these inflamed segments. Seventeen stenoses could be identified in 43 CD patients. With regard to assessment as inflammatory or fibrotic stenosis, there was good concordance between colonoscopy, hydro-MRI, and FDG-PET. In one case only, the nature of the stenosis was assessed differently. In contrast with leukocyte numbers and CDAI, there was significant correlation of FDG-PET activity with C-reactive protein and CDEIS levels (P = 0.019 and P = 0.007, respectively).
  
  
  CONCLUSIONS
  FDG-PET is able to detect mucosal inflammation in CD with high sensitivity and specificity and to enable proper assessment of inflammatory activity in stenoses. FDG-PET is, thus, a promising non-invasive technique for clinical management of CD.
authors.affiliation: 1st Department of Medicine, Johannes Gutenberg-University, 55131 Mainz, Langenbeckstrasse 1, Mainz, Germany. mholtman@mail.uni-mainz.de
authors.forename: Martin H
authors.initials: MH
authors.lastname: Holtmann
authors.forename: Manuela
authors.initials: M
authors.lastname: Uenzen
authors.forename: Andreas
authors.initials: A
authors.lastname: Helisch
authors.forename: Anja
authors.initials: A
authors.lastname: Dahmen
authors.forename: Jonas
authors.initials: J
authors.lastname: Mudter
authors.forename: Martin
authors.initials: M
authors.lastname: Goetz
authors.forename: Mathias
authors.initials: M
authors.lastname: Schreckenberger
authors.forename: Peter R
authors.initials: PR
authors.lastname: Galle
authors.forename: Peter
authors.initials: P
authors.lastname: Bartenstein
authors.forename: Markus F
authors.initials: MF
authors.lastname: Neurath
mesh_terms: D000328:Adult; D003113:Colonoscopy; D003424:Crohn Disease / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18