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DOI: 10.1148/rg.271065080
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Bowel Hot Spots at PET-CT1

Hima B. Prabhakar, MD, Dushyant V. Sahani, MD, Alan J. Fischman, MD, PhD, Peter R. Mueller, MD and Michael A. Blake, MRCPI, FRCR, FFR(RCSI)

1 From the Department of Radiology, Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114. Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received April 25, 2006; revision requested May 24 and received September 11; accepted September 25. All authors have no financial relationships to disclose.

Figure 1
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  		Figure 1a.  Bowel distention. Axial and coronal fused PET-CT images obtained after the oral administration of 1800 mL of VoLumen (E-Z-EM) demonstrate distention of the stomach (a), small bowel (b), and colon (c) (arrow).

 

Figure 1
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  		Figure 1b.  Bowel distention. Axial and coronal fused PET-CT images obtained after the oral administration of 1800 mL of VoLumen (E-Z-EM) demonstrate distention of the stomach (a), small bowel (b), and colon (c) (arrow).

 

Figure 1
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  		Figure 1c.  Bowel distention. Axial and coronal fused PET-CT images obtained after the oral administration of 1800 mL of VoLumen (E-Z-EM) demonstrate distention of the stomach (a), small bowel (b), and colon (c) (arrow).

 

Figure 2
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  		Figure 2a.  Diffuse physiologic bowel uptake in a 47-year-old human immunodeficiency virus–positive man with T-cell lymphoma. Coronal fused PET-CT image (a) and unfused PET scan (b) show diffuse low-level physiologic FDG uptake throughout the small and large bowel. No focal FDG uptake is identified. Note the slightly more prominent uptake within the cecum and right colon, which may be secondary to a relatively high concentration of lymphocytes in this region.

 

Figure 2
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  		Figure 2b.  Diffuse physiologic bowel uptake in a 47-year-old human immunodeficiency virus–positive man with T-cell lymphoma. Coronal fused PET-CT image (a) and unfused PET scan (b) show diffuse low-level physiologic FDG uptake throughout the small and large bowel. No focal FDG uptake is identified. Note the slightly more prominent uptake within the cecum and right colon, which may be secondary to a relatively high concentration of lymphocytes in this region.

 

Figure 3
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  		Figure 3a.  Heterogeneous physiologic bowel uptake in a 43-year-old woman with nasopharyngeal lymphoma. Coronal fused PET-CT image (a) and unfused PET scan (b) show mild FDG uptake at the fundus of the stomach and heterogeneous FDG uptake throughout the small and large bowel, without prominent focal-segmental uptake. The patient had no small or large bowel disease; thus, these findings again represent a normal variant of physiologic bowel uptake (cf Fig 2).

 

Figure 3
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  		Figure 3b.  Heterogeneous physiologic bowel uptake in a 43-year-old woman with nasopharyngeal lymphoma. Coronal fused PET-CT image (a) and unfused PET scan (b) show mild FDG uptake at the fundus of the stomach and heterogeneous FDG uptake throughout the small and large bowel, without prominent focal-segmental uptake. The patient had no small or large bowel disease; thus, these findings again represent a normal variant of physiologic bowel uptake (cf Fig 2).

 

Figure 4
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  		Figure 4a.  Esophagitis in a 63-year-old woman with nasopharyngeal carcinoma who presented with complaints of xerostomia and dysphagia. The patient was undergoing chemotherapy and radiation therapy. (a) Coronal staging CT scan shows mild esophageal thickening involving the middle to distal esophagus (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate linear low-level FDG uptake (arrow), a finding that corresponds to the esophageal thickening seen at CT.

 

Figure 4
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  		Figure 4b.  Esophagitis in a 63-year-old woman with nasopharyngeal carcinoma who presented with complaints of xerostomia and dysphagia. The patient was undergoing chemotherapy and radiation therapy. (a) Coronal staging CT scan shows mild esophageal thickening involving the middle to distal esophagus (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate linear low-level FDG uptake (arrow), a finding that corresponds to the esophageal thickening seen at CT.

 

Figure 4
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  		Figure 4c.  Esophagitis in a 63-year-old woman with nasopharyngeal carcinoma who presented with complaints of xerostomia and dysphagia. The patient was undergoing chemotherapy and radiation therapy. (a) Coronal staging CT scan shows mild esophageal thickening involving the middle to distal esophagus (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate linear low-level FDG uptake (arrow), a finding that corresponds to the esophageal thickening seen at CT.

 

Figure 5
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  		Figure 5a.  Esophageal adenocarcinoma in a 59-year-old man who presented with progressive dysphagia and weight loss. Upper endoscopy demonstrated a distal esophageal mass, and biopsy revealed poorly differentiated esophageal adenocarcinoma. (a) Coronal CT scan demonstrates a partially obstructive distal esophageal mass with proximal esophageal dilatation (arrow). (b, c) Coronal PET-CT image (b) and PET scan (c) demonstrate intense FDG uptake (arrow) corresponding to the CT findings.

 

Figure 5
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  		Figure 5b.  Esophageal adenocarcinoma in a 59-year-old man who presented with progressive dysphagia and weight loss. Upper endoscopy demonstrated a distal esophageal mass, and biopsy revealed poorly differentiated esophageal adenocarcinoma. (a) Coronal CT scan demonstrates a partially obstructive distal esophageal mass with proximal esophageal dilatation (arrow). (b, c) Coronal PET-CT image (b) and PET scan (c) demonstrate intense FDG uptake (arrow) corresponding to the CT findings.

 

Figure 5
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  		Figure 5c.  Esophageal adenocarcinoma in a 59-year-old man who presented with progressive dysphagia and weight loss. Upper endoscopy demonstrated a distal esophageal mass, and biopsy revealed poorly differentiated esophageal adenocarcinoma. (a) Coronal CT scan demonstrates a partially obstructive distal esophageal mass with proximal esophageal dilatation (arrow). (b, c) Coronal PET-CT image (b) and PET scan (c) demonstrate intense FDG uptake (arrow) corresponding to the CT findings.

 

Figure 6
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  		Figure 6a.  Gastritis in a 57-year-old man with Hodgkin lymphoma of the left groin. (a) CT scan shows gastric wall thickening (arrow). (b, c) Axial fused PET-CT image (b) and PET scan (c) demonstrate intense FDG uptake involving the gastric fundus and body (arrow), a finding that corresponds to the gastric wall thickening seen at CT. (d) CT scan obtained following treatment with ranitidine shows a moderate decrease in gastric wall thickening (arrow). (e, f ) Axial fused PET-CT image (e) and PET scan (f ) demonstrate markedly decreased FDG uptake involving the stomach (arrow) compared with the pretreatment images (cf a–c).

 

Figure 6
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  		Figure 6b.  Gastritis in a 57-year-old man with Hodgkin lymphoma of the left groin. (a) CT scan shows gastric wall thickening (arrow). (b, c) Axial fused PET-CT image (b) and PET scan (c) demonstrate intense FDG uptake involving the gastric fundus and body (arrow), a finding that corresponds to the gastric wall thickening seen at CT. (d) CT scan obtained following treatment with ranitidine shows a moderate decrease in gastric wall thickening (arrow). (e, f ) Axial fused PET-CT image (e) and PET scan (f ) demonstrate markedly decreased FDG uptake involving the stomach (arrow) compared with the pretreatment images (cf a–c).

 

Figure 6
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  		Figure 6c.  Gastritis in a 57-year-old man with Hodgkin lymphoma of the left groin. (a) CT scan shows gastric wall thickening (arrow). (b, c) Axial fused PET-CT image (b) and PET scan (c) demonstrate intense FDG uptake involving the gastric fundus and body (arrow), a finding that corresponds to the gastric wall thickening seen at CT. (d) CT scan obtained following treatment with ranitidine shows a moderate decrease in gastric wall thickening (arrow). (e, f ) Axial fused PET-CT image (e) and PET scan (f ) demonstrate markedly decreased FDG uptake involving the stomach (arrow) compared with the pretreatment images (cf a–c).

 

Figure 6
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  		Figure 6d.  Gastritis in a 57-year-old man with Hodgkin lymphoma of the left groin. (a) CT scan shows gastric wall thickening (arrow). (b, c) Axial fused PET-CT image (b) and PET scan (c) demonstrate intense FDG uptake involving the gastric fundus and body (arrow), a finding that corresponds to the gastric wall thickening seen at CT. (d) CT scan obtained following treatment with ranitidine shows a moderate decrease in gastric wall thickening (arrow). (e, f ) Axial fused PET-CT image (e) and PET scan (f ) demonstrate markedly decreased FDG uptake involving the stomach (arrow) compared with the pretreatment images (cf a–c).

 

Figure 6
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  		Figure 6e.  Gastritis in a 57-year-old man with Hodgkin lymphoma of the left groin. (a) CT scan shows gastric wall thickening (arrow). (b, c) Axial fused PET-CT image (b) and PET scan (c) demonstrate intense FDG uptake involving the gastric fundus and body (arrow), a finding that corresponds to the gastric wall thickening seen at CT. (d) CT scan obtained following treatment with ranitidine shows a moderate decrease in gastric wall thickening (arrow). (e, f ) Axial fused PET-CT image (e) and PET scan (f ) demonstrate markedly decreased FDG uptake involving the stomach (arrow) compared with the pretreatment images (cf a–c).

 

Figure 6
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  		Figure 6f.  Gastritis in a 57-year-old man with Hodgkin lymphoma of the left groin. (a) CT scan shows gastric wall thickening (arrow). (b, c) Axial fused PET-CT image (b) and PET scan (c) demonstrate intense FDG uptake involving the gastric fundus and body (arrow), a finding that corresponds to the gastric wall thickening seen at CT. (d) CT scan obtained following treatment with ranitidine shows a moderate decrease in gastric wall thickening (arrow). (e, f ) Axial fused PET-CT image (e) and PET scan (f ) demonstrate markedly decreased FDG uptake involving the stomach (arrow) compared with the pretreatment images (cf a–c).

 

Figure 7
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  		Figure 7a.  GIST in a 67-year-old man. The mass was incidentally detected at upper endoscopy performed to evaluate for guaiac-positive stool. (a) CT scan shows a proximal soft-tissue gastric mass (arrow). (b, c) Axial fused PET-CT image (b) and PET scan (c) demonstrate increased FDG uptake (arrow), a finding that corresponds to the mass seen at CT. Biopsy of the mass revealed a GIST.

 

Figure 7
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  		Figure 7b.  GIST in a 67-year-old man. The mass was incidentally detected at upper endoscopy performed to evaluate for guaiac-positive stool. (a) CT scan shows a proximal soft-tissue gastric mass (arrow). (b, c) Axial fused PET-CT image (b) and PET scan (c) demonstrate increased FDG uptake (arrow), a finding that corresponds to the mass seen at CT. Biopsy of the mass revealed a GIST.

 

Figure 7
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  		Figure 7c.  GIST in a 67-year-old man. The mass was incidentally detected at upper endoscopy performed to evaluate for guaiac-positive stool. (a) CT scan shows a proximal soft-tissue gastric mass (arrow). (b, c) Axial fused PET-CT image (b) and PET scan (c) demonstrate increased FDG uptake (arrow), a finding that corresponds to the mass seen at CT. Biopsy of the mass revealed a GIST.

 

Figure 8
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  		Figure 8a.  Infectious enteritis in a 50-year-old human immunodeficiency virus–positive man with diffuse adenopathy of unknown cause. (a) Coronal CT scan obtained after the administration of negative oral contrast material for small bowel distention clearly demonstrates mild ileal wall thickening (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate diffuse low-level uptake within loops of ileum (arrow). Stool cultures were positive for Salmonella and Campylobacter species.

 

Figure 8
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  		Figure 8b.  Infectious enteritis in a 50-year-old human immunodeficiency virus–positive man with diffuse adenopathy of unknown cause. (a) Coronal CT scan obtained after the administration of negative oral contrast material for small bowel distention clearly demonstrates mild ileal wall thickening (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate diffuse low-level uptake within loops of ileum (arrow). Stool cultures were positive for Salmonella and Campylobacter species.

 

Figure 8
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  		Figure 8c.  Infectious enteritis in a 50-year-old human immunodeficiency virus–positive man with diffuse adenopathy of unknown cause. (a) Coronal CT scan obtained after the administration of negative oral contrast material for small bowel distention clearly demonstrates mild ileal wall thickening (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate diffuse low-level uptake within loops of ileum (arrow). Stool cultures were positive for Salmonella and Campylobacter species.

 

Figure 9
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  		Figure 9a.  Terminal ileitis in a 62-year-old man with a solitary pulmonary nodule and a prior history of Crohn disease. (a) Coronal CT scan shows wall thickening in the terminal ileum (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate segmental increased FDG uptake (arrow), a finding that corresponds to the CT finding and is consistent with the patient’s history of Crohn disease.

 

Figure 9
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  		Figure 9b.  Terminal ileitis in a 62-year-old man with a solitary pulmonary nodule and a prior history of Crohn disease. (a) Coronal CT scan shows wall thickening in the terminal ileum (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate segmental increased FDG uptake (arrow), a finding that corresponds to the CT finding and is consistent with the patient’s history of Crohn disease.

 

Figure 9
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  		Figure 9c.  Terminal ileitis in a 62-year-old man with a solitary pulmonary nodule and a prior history of Crohn disease. (a) Coronal CT scan shows wall thickening in the terminal ileum (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate segmental increased FDG uptake (arrow), a finding that corresponds to the CT finding and is consistent with the patient’s history of Crohn disease.

 

Figure 10
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  		Figure 10a.  Collagenous colitis in a 69-year-old woman with bladder, ovarian, and lung cancer. (a) Coronal CT scan demonstrates no evidence of colonic wall thickening (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate increased FDG uptake involving the ascending colon (arrow). Colonoscopy and subsequent biopsy revealed collagenous colitis, a rare condition that is diagnosed in patients with chronic watery diarrhea in whom conventional radiography or endoscopy demonstrates a healthy colon but colonic biopsies show unique inflammatory changes. The characteristic features of collagenous colitis are infiltration of lymphocytes into the colonic epithelium and distinctive thickening of the subepithelial collagen table.

 

Figure 10
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  		Figure 10b.  Collagenous colitis in a 69-year-old woman with bladder, ovarian, and lung cancer. (a) Coronal CT scan demonstrates no evidence of colonic wall thickening (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate increased FDG uptake involving the ascending colon (arrow). Colonoscopy and subsequent biopsy revealed collagenous colitis, a rare condition that is diagnosed in patients with chronic watery diarrhea in whom conventional radiography or endoscopy demonstrates a healthy colon but colonic biopsies show unique inflammatory changes. The characteristic features of collagenous colitis are infiltration of lymphocytes into the colonic epithelium and distinctive thickening of the subepithelial collagen table.

 

Figure 10
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  		Figure 10c.  Collagenous colitis in a 69-year-old woman with bladder, ovarian, and lung cancer. (a) Coronal CT scan demonstrates no evidence of colonic wall thickening (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate increased FDG uptake involving the ascending colon (arrow). Colonoscopy and subsequent biopsy revealed collagenous colitis, a rare condition that is diagnosed in patients with chronic watery diarrhea in whom conventional radiography or endoscopy demonstrates a healthy colon but colonic biopsies show unique inflammatory changes. The characteristic features of collagenous colitis are infiltration of lymphocytes into the colonic epithelium and distinctive thickening of the subepithelial collagen table.

 

Figure 11
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  		Figure 11a.  Perforated diverticulitis in a 64-year-old man who had recently undergone left hemicolectomy for stage IIIB colon cancer. (a) Coronal CT scan shows diverticulitis with perforation, small extraluminal collections, and pericolonic inflammatory changes (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate FDG uptake in the sigmoid colon (arrow), a finding that corresponds to the CT findings.

 

Figure 11
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  		Figure 11b.  Perforated diverticulitis in a 64-year-old man who had recently undergone left hemicolectomy for stage IIIB colon cancer. (a) Coronal CT scan shows diverticulitis with perforation, small extraluminal collections, and pericolonic inflammatory changes (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate FDG uptake in the sigmoid colon (arrow), a finding that corresponds to the CT findings.

 

Figure 11
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  		Figure 11c.  Perforated diverticulitis in a 64-year-old man who had recently undergone left hemicolectomy for stage IIIB colon cancer. (a) Coronal CT scan shows diverticulitis with perforation, small extraluminal collections, and pericolonic inflammatory changes (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate FDG uptake in the sigmoid colon (arrow), a finding that corresponds to the CT findings.

 

Figure 12
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  		Figure 12a.  Perianal fistula in a 49-year-old man with longstanding Crohn disease who presented with rectal cancer. (a) Coronal CT scan shows a perianal fistula with a small abscess (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate focal FDG uptake in the region of the anus (arrow), a finding that corresponds to the fistula seen at CT.

 

Figure 12
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  		Figure 12b.  Perianal fistula in a 49-year-old man with longstanding Crohn disease who presented with rectal cancer. (a) Coronal CT scan shows a perianal fistula with a small abscess (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate focal FDG uptake in the region of the anus (arrow), a finding that corresponds to the fistula seen at CT.

 

Figure 12
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  		Figure 12c.  Perianal fistula in a 49-year-old man with longstanding Crohn disease who presented with rectal cancer. (a) Coronal CT scan shows a perianal fistula with a small abscess (arrow). (b, c) Coronal fused PET-CT image (b) and PET scan (c) demonstrate focal FDG uptake in the region of the anus (arrow), a finding that corresponds to the fistula seen at CT.

 

Figure 13
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  		Figure 13a.  Poorly differentiated rectal adenocarcinoma in a 71-year-old man. (a) Sagittal CT scan demonstrates an enhancing soft-tissue mass along the posterior rectum (arrow). (b, c) Sagittal fused PET-CT image (b) and PET scan (c) demonstrate marked FDG uptake in the rectum (arrow), a finding that corresponds to the mass seen at CT.

 

Figure 13
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  		Figure 13b.  Poorly differentiated rectal adenocarcinoma in a 71-year-old man. (a) Sagittal CT scan demonstrates an enhancing soft-tissue mass along the posterior rectum (arrow). (b, c) Sagittal fused PET-CT image (b) and PET scan (c) demonstrate marked FDG uptake in the rectum (arrow), a finding that corresponds to the mass seen at CT.

 

Figure 13
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  		Figure 13c.  Poorly differentiated rectal adenocarcinoma in a 71-year-old man. (a) Sagittal CT scan demonstrates an enhancing soft-tissue mass along the posterior rectum (arrow). (b, c) Sagittal fused PET-CT image (b) and PET scan (c) demonstrate marked FDG uptake in the rectum (arrow), a finding that corresponds to the mass seen at CT.

 




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