title: Focal colorectal uptake in (18)FDG-PET/CT: maximum standard uptake value as a trigger in a semi-automated screening setting.
abstract: BACKGROUND
  Focal colorectal uptake in (18)FDG-PET/CT may be associated with a malignancy and can be quantified. This provides the basis for an automatic trigger threshold above which cases are flagged for colonoscopic evaluation and below which for individual assessment.
  
  
  OBJECTIVE
  To determine the lowest maximum standard uptake (SUVmax) in colorectal cancer that could be used as a threshold to trigger endoscopic evaluation and to evaluate whether the SUVmax needs to be further normalised to a priori known extrinsic factors.
  
  
  METHODS
  The SUVmax was measured in 54 colorectal carcinomas and correlated with gender, age, blood glucose level, injected activity, body mass index and time to scan using t test or correlation coefficients (Pearson or Spearman, according to distribution).
  
  
  RESULTS
  There was no correlation between SUVmax and any of the extrinsic factors mentioned above. The lowest SUVmax value was 5 [mean ± SD (range): 11.1 ± 4.8 (5.0-24.6)].
  
  
  CONCLUSIONS
  In contrast to most other screening techniques, semi-automation in colorectal screening seems possible with PET/CT. This opens the door for further study into the feasibility of automated screening. Independent from extrinsic factors, an SUVmax ≥5.0 in a focal colorectal uptake in (18)FDG-PET/CT should automatically trigger for endoscopic evaluation, if not contraindicated. Cases with SUVmax <5 should be assessed individually before referral for endoscopy. Thus, more interpretation time could be spent on those cases with a lower uptake and more ambiguous diagnosis.
authors.affiliation: Department of Radiology, Johann Wolfgang von Goethe University Hospital, Frankfurt, Germany. luboldt@screening.org.|Multiorgan Screening Foundation (www.multiorganscreening.org), Munich, Germany. luboldt@screening.org.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Luboldt
authors.affiliation: Institute of Medical Informatics and Biometry, University Hospital, Dresden, Germany. baerbel.wiedemann@tu-dresden.de.
authors.forename: Baerbel
authors.initials: B
authors.lastname: Wiedemann
authors.affiliation: Department of Radiology, Johann Wolfgang von Goethe University Hospital, Frankfurt, Germany. Sebastian.Fischer@kgu.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Fischer
authors.affiliation: Department of Radiology, Johann Wolfgang von Goethe University Hospital, Frankfurt, Germany. bbodelle@googlemail.com.
authors.forename: Boris
authors.initials: B
authors.lastname: Bodelle
authors.affiliation: Multiorgan Screening Foundation (www.multiorganscreening.org), Munich, Germany. luboldt@screening.org.
authors.forename: Hans Joachim
authors.initials: HJ
authors.lastname: Luboldt
authors.affiliation: Department of Nuclear Medicine, Johann Wolfgang von Goethe University Hospital, Frankfurt, Germany. Gruenwald@em.uni-frankfurt.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Grünwald
authors.affiliation: Department of Radiology, Johann Wolfgang von Goethe University Hospital, Frankfurt, Germany. T.Vogl@em.uni-frankfurt.de.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Vogl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000000981:diagnostic imaging / Q000378:metabolism; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019788:Fluorodeoxyglucose F18