title: Differentiation of incidental intestinal activities at PET/CT examinations with a new sign: peristaltic segment sign.
abstract: OBJECTIVE
  The aim of this study was to present the effect of the peristaltic segment sign for the differential diagnosis between malignant, physiological and gastrointestinal focal fluorodeoxyglucose (FDG) uptakes as an alternative method to maximum standardized uptake value (SUVmax).
  
  
  METHODS
  Gastrointestinal tract (GIT) sections of 823 FDG positron emission tomography/computed tomography (FDG-PET/CT) performed in our center were reviewed retrospectively. Images of these cases that have been reported for positive intestinal focal FDG uptake areas were included. Through the sectional images, any accompanying short segment expanded with air just after or before the uptake area was marked as "positive peristaltism sign". The cases were confirmed with endoscopy plus biopsy (n:42), endoscopy (n:5), laparotomy (n:1), transabdominal biopsy (n:1), enteroclysis (n:1), CT-colonoscopy (n:5), rectal contrast enhanced CT (n:4). Distinguishing features of the sign were analyzed statistically compared to the conventional method for differentiation of malignity.
  
  
  RESULTS
  Localized FDG uptake was reported in 59 of 823 cases. A SUVmax greater than 2.5 with intestinal wall thickening allowed the diagnosis of malignity with sensitivity 33%, specificity 65%, positive predictive value 69% and negative predictive value 46%. The peristaltic segment sign, considered as a benign finding, increased the statistical values to 68%, 80%, 82% and 65%, respectively.
  
  
  CONCLUSIONS
  In case of gastrointestinal increased focal FDG uptake, the new parameter of peristaltic segment sign may differentiate the physiologic uptakes from the malignant ones more accurately than the conventional SUVmax.
authors: Kasimpasa Military Hospital, Department of Radiology, Istanbul, Turkey.
authors: Duzgun
authors: D
authors: Yildirim
authors: Muge Oner
authors: MO
authors: Tamam
authors: Mutlu
authors: M
authors: Sahin
authors: Baki
authors: B
authors: Ekci
authors: Bengi
authors: B
authors: Gurses
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D007422:Intestines / Q000000981:diagnostic imaging* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D010528:Peristalsis / Q000502:physiology*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18