title: Significance of 18F-Fluorodeoxyglucose Uptake at the Gastroesophageal Junction: Comparison of PET to Esophagogastroduodenoscopy.
abstract: BACKGROUND
  Positron emission tomography-computed tomography (PET/CT) occasionally reveals unexpected uptake of (18)F-fluorodeoxyglucose ((18)F-FDG) at the gastroesophageal junction (GEJ). The aim of this study was to determine the importance of unexpected (18)F-FDG uptake at the GEJ on PET/CT by correlating this finding with endoscopy results.
  
  
  METHODS
  We reviewed medical records from June 2009 to October 2012 to identify patients in our Veterans Affairs Medical Center who had an esophagogastroduodenoscopy (EGD) performed within 6 months of a PET/CT. Metabolic activity at the GEJ was quantified with standardized uptake values (SUV) and correlated with EGD and histopathology results.
  
  
  RESULTS
  A total of 219 patients were identified and assigned to one of five groups based upon EGD findings: esophageal malignancy (n = 34), esophagitis (n = 21), Barrett's esophagus (n = 8), other non-malignant disorders (n = 5), and normal (n = 151). The mean SUV Max for the groups was 6.72, 2.47, 2.40, 3.48, and 2.06, respectively. SUV Max and SUV Mean were significantly higher in the esophageal malignancy group than in all other groups (p < 0.001). SUV for patients with high-grade esophagitis was greater than in patients with low-grade esophagitis. A SUV Max ≥ 3.5 was found to predict necessity for EGD with a positive predictive value of 79 %. A SUV Max ≤ 2.2 yielded a negative predictive value of 86 %.
  
  
  CONCLUSIONS
  Differentiation between benign and potentially significant disease at the GEJ may be possible with quantification of incidental (18)F-FDG uptake at PET/CT. Our results suggest thresholds that may help determine need for further endoscopic evaluation in patients with abnormal metabolic activity at the GEJ.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9030, USA, stagg.joshua@gmail.com.
authors.forename: Joshua
authors.initials: J
authors.lastname: Stagg
authors.forename: Irfan
authors.initials: I
authors.lastname: Farukhi
authors.forename: Francisco
authors.initials: F
authors.lastname: Lazaga
authors.forename: Chiarra
authors.initials: C
authors.lastname: Thompson
authors.forename: Ledjona
authors.initials: L
authors.lastname: Bradshaw
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kaif
authors.forename: Aron
authors.initials: A
authors.lastname: Gould-Simon
authors.forename: Robert
authors.initials: R
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001471:Barrett Esophagus / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System; D004935:Esophageal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D004941:Esophagitis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012372:ROC Curve; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18