Interesting Image

Incidental Detection of Pseudomembranous Colitis Through 18F-FDG PET/CT During the Restaging of Colorectal Cancer

10.4274/mirt.galenos.2022.94547

  • Luca Filippi

Received Date: 28.10.2021 Accepted Date: 18.01.2022 Mol Imaging Radionucl Ther 2023;32(1):71-73 PMID: 36820009

A 59-year-old man, previously submitted to anterior resection due to rectal cancer, underwent a contrast-enhanced computed tomography (ce-CT) for restaging before eventual chemotherapy. Because ce-CT showed a moderate enlargement of the descending colonic lumen, in despite the lack of symptoms, positron emission tomography (PET)/CT 18F-fluorodeoxyglucose (FDG) was carried out. 18F-FDG PET/CT demonstrated highly increased tracer incorporation along the colon walls. Two days after the PET/CT examination, complaints of diarrhea and abdominal pain began. Clostridioides difficile stool test resulted positiv; thus, thus he started antibiotic therapy without benefit. Because follow-up ce-CT demonstrated a megacolon condition, he was submitted to hemicolectomy. Histology revealed a diffuse condition of pseudomembranous colitis (PMC). This case highlights the potential of 18F-FDG PET/CT for detecting PMC morphological and functional features also in pre-symptomatic patients.

Keywords: Inflammatio, 18F-FDG, positron emission tomograph, colitis

Ethics

Informed Consent: Patient consent was obtained before PET/CT examination.

Peer-review: Externally peer-reviewed.

Financial Disclosure: The author declared that this study has received no financial support.

Images

  1. Pijl JP, Nienhuis PH, Kwee TC, Glaudemans AWJM, Slart RHJA, Gormsen LC. Limitations and Pitfalls of FDG-PET/CT in infection and inflammation. Semin Nucl Med 2021;51:633-645.
  2. Djekidel M, Brown RK, Piert M. Benefits of hybrid SPECT/CT for (111)In-oxine- and Tc-99m-hexamethylpropylene amine oxime-labeled leukocyte imaging. Clin Nucl Med 2011;36:e50-e56.
  3. Filippi L, Biancone L, Petruzziello C, Schillaci O. Tc-99m HMPAO-labeled leukocyte scintigraphy with hybrid SPECT/CT detects perianal fistulas in Crohn disease. Clin Nucl Med 2006;31:541-542.
  4. Vaidyanathan S, Patel CN, Scarsbrook AF, Chowdhury FU. FDG PET/CT in infection and inflammation--current and emerging clinical applications. Clin Radiol 2015;70:787-800.
  5. Ahn BC, Lee SW, Lee J. Intense accumulation of F-18 FDG in colonic wall in adult onset still disease with pseudomembranous colitis. Clin Nucl Med 2008;33:806-808.
  6. Cussó L, Reigadas E, Muñoz P, Desco M, Bouza E. Evaluation of Clostridium difficile Infection with PET/CT Imaging in a Mouse Model. Mol Imaging Biol 2020;22:587-592.
  7. Hannah A, Scott AM, Akhurst T, Berlangieri S, Bishop J, McKay WJ. Abnormal colonic accumulation of fluorine-18-FDG in pseudomembranous colitis. J Nucl Med 1996;37:1683-1685.
  8. Venkat R, Pandit V, Telemi E, Trofymenko O, Pandian TK, Nfonsam VN. Frailty predicts morbidity and mortality after colectomy for clostridium difficile colitis. Am Surg 2018;84:628-632.