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Huang K, Garuba F, Ganapathy A, Bishop G, Zhang H, Lovato A, Itani M, Viswanath SE, Fraum TJ, Deepak P, Ballard DH. Quantifying 18F-Fluorodeoxyglucose Uptake in Perianal Fistulas on PET/CT: A Retrospective Analysis. Acad Radiol 2024:S1076-6332(23)00695-5. [PMID: 38177032 DOI: 10.1016/j.acra.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024]
Abstract
RATIONALE AND OBJECTIVES The use of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT) in assessing inflammatory diseases has shown significant promise. Uptake patterns in perianal fistulas, which may be an incidental finding on PET/CT, have not been purposefully studied. Our aim was to compare FDG uptake of perianal fistulas to that of the liver and anal canal in patients who underwent PET/CT for hematologic/oncologic diagnosis or staging. MATERIALS AND METHODS We retrospectively identified patients who underwent FDG-PET/CT imaging between January 2011 and May 2023, where the report described a perianal fistula or abscess. PET/CTs of patients included in the study were retrospectively analyzed to record the maximum standardized uptake value (SUVmax) of the fistula, abscess, anal canal, rectum, and liver. Fistula-to-liver and Fistula-to-anus SUVmax ratios were calculated. We statistically compared FDG activity among the fistula, liver, and anal canal. We also assessed FDG activity in patients with vs. without anorectal cancer, as well as across different St. James fistula grades. RESULTS The study included 24 patients with identifiable fistulas. Fistula SUVmax (mean=10.8 ± 5.28) was significantly higher than both the liver (mean=3.09 ± 0.584, p < 0.0001) and the anal canal (mean=5.98 ± 2.63, p = 0.0005). Abscess fistula SUVmax was 15.8 ± 4.91. St. James grade 1 fistulas had significantly lower SUVmax compared to grades 2 and 4 (p = 0.0224 and p = 0.0295, respectively). No significant differences existed in SUVmax ratios between anorectal and non-anorectal cancer groups. CONCLUSION Perianal fistulas have increased FDG avidity with fistula SUVmax values that are significantly higher than the anal canal.
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Affiliation(s)
- Katherine Huang
- Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA (K.H., P.D.)
| | - Favour Garuba
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA (F.G., A.G.)
| | - Aravinda Ganapathy
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA (F.G., A.G.)
| | - Grace Bishop
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S. Kingshighway Blvd, Campus Stop 8131, St. Louis, Missouri, 63110, USA (G.B., H.Z., A.L., M.I., T.J.F., D.H.B.)
| | - Hanjing Zhang
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S. Kingshighway Blvd, Campus Stop 8131, St. Louis, Missouri, 63110, USA (G.B., H.Z., A.L., M.I., T.J.F., D.H.B.)
| | - Adriene Lovato
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S. Kingshighway Blvd, Campus Stop 8131, St. Louis, Missouri, 63110, USA (G.B., H.Z., A.L., M.I., T.J.F., D.H.B.)
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S. Kingshighway Blvd, Campus Stop 8131, St. Louis, Missouri, 63110, USA (G.B., H.Z., A.L., M.I., T.J.F., D.H.B.)
| | - Satish E Viswanath
- Department of Biomedical Engineering, School of Engineering, Case Western Reserve University, Cleveland, Ohio, USA (S.E.V.)
| | - Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S. Kingshighway Blvd, Campus Stop 8131, St. Louis, Missouri, 63110, USA (G.B., H.Z., A.L., M.I., T.J.F., D.H.B.)
| | - Parakkal Deepak
- Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA (K.H., P.D.)
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S. Kingshighway Blvd, Campus Stop 8131, St. Louis, Missouri, 63110, USA (G.B., H.Z., A.L., M.I., T.J.F., D.H.B.).
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