Combined SUVmax and localized colonic wall thickening parameters to identify high-risk lesions from incidental focal colorectal (18)F-FDG uptake foci

OBJECTIVE: To evaluate the detection ability of (18)F-FDG PET/CT for identifying high-risk lesions (high-risk adenomas and adenocarcinoma) from incidental focal colorectal (18)F-FDG uptake foci combining maximum standard uptake value (SUVmax) and localized colonic wall thickening (CWT). The secondary objective was to investigate the factors of missed detection of high-risk adenomas by (18)F-FDG PET/CT. PATIENTS AND METHODS: A total of 6394 patients who underwent (18)F-FDG PET/CT in our hospital from August 2019 to December 2021 were retrospectively analysed, and 145 patients with incidental focal colorectal (18)F-FDG uptake foci were identified. The optimal cut-off value of SUVmax for (18)F-FDG PET/CT diagnosis of high-risk lesions was determined by receiver operating characteristic (ROC) curves. SUVmax and localized CWT were combined to identify high-risk lesions from incidental focal colorectal (18)F-FDG uptake foci. The characteristics of incidental adenomas detected and high-risk adenomas missed by (18)F-FDG PET/CT were compared. RESULTS: Of the 6394 patients, 145 patients were found to have incidental focal colorectal FDG uptake foci (2.3%), and 44 patients underwent colonoscopy and pathological examination at the same time. In fact, 45 lesions, including 12 low-risk lesions and 33 high-risk lesions (22 high-risk adenomas, 11 adenocarcinoma), were found by colonoscopy. The area under the ROC curve of SUVmax for low-risk lesions and high-risk lesions was 0.737, and the optimal cut-off value was 6.45 (with a sensitivity of 87.9% and specificity of 58.3%). When SUVmax ≥6.45, the combination of localized CWT parameters has little influence on the sensitivity and specificity of detection; when SUVmax <6.45, the combination of localized CWT parameters can improve the specificity of detection of high-risk lesions, but the sensitivity has little change. In addition, the size of high-risk adenomas discovered incidentally by (18)F-FDG PET/CT was larger than that of high-risk adenomas missed, but there was no significant difference in lesion location, pathological type or intraepithelial neoplasia between the two groups. CONCLUSIONS: The combination of SUVmax and localized CWT parameters of (18)F-FDG PET/CT helped identify high-risk lesions from incidental focal colorectal (18)F-FDG uptake foci, especially for lesions with SUVmax <6.45. Lesion size may be the only factor in (18)F-FDG PET/CT missing high-risk adenomas.