J Gastric Cancer.  2014 Mar;14(1):1-6.

Imaging of Gastric Cancer Metabolism Using 18 F-FDG PET/CT

Affiliations
  • 1Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea. yunmijin@yumc.yonsei.ac.kr

Abstract

Aerobic glycolysis has been the most important hypothesis in cancer metabolism. It seems to be related to increased bioenergetic and biosynthetic needs in rapidly proliferating cancer cells. To this end, F-18 fluorodeoxyglucose (FDG), a glucose analog, became widely popular for the detection of malignancies combined with positron emission tomography/computed tomography (PET/CT). Although the potential roles of FDG PET/CT in primary tumor detection are not fully established, it seems to have a limited sensitivity in detecting early gastric cancer and mainly signet ring or non-solid types of advanced gastric cancer. In evaluating lymph node metastases, the location of lymph nodes and the degree of FDG uptake in primary tumors appear to be important factors affecting the diagnostic accuracy of PET/CT. In spite of the limited sensitivity, the high specificity of PET/CT for lymph node metastases may play an important role in changing the extent of lymphadenectomy or reducing futile laparotomies. For peritoneal metastases, PET/CT seems to have a poorer sensitivity but a better specificity than CT. The roles of PET/CT in the evaluation of other distant metastases are yet to be known. Studies including primary tumors with low FDG uptake or peritoneal recurrence seem suffer from poorer diagnostic performance for the detection of recurrent gastric cancer. There are only a few reports using FDG PET/CT to predict response to neoadjuvant or adjuvant chemotherapy. A complete metabolic response seems to be predictive of more favorable prognosis.

Keyword

Stomach neoplasms; Positron emission tomography/computed tomography; Fluorodeoxyglucose; Metabolism; Glycolysis

MeSH Terms

Chemotherapy, Adjuvant
Electrons
Energy Metabolism
Glucose
Glycolysis
Laparotomy
Lymph Node Excision
Lymph Nodes
Metabolism*
Neoplasm Metastasis
Positron-Emission Tomography and Computed Tomography*
Prognosis
Recurrence
Sensitivity and Specificity
Stomach Neoplasms*
Glucose

Figure

  • Fig. 1 Histopathologic factors affecting fluorodeoxyglucose (FDG) uptake in advanced gastric cancers (AGCs). (A, B, C) AGC with intense FDG uptake (arrows) and intestinal growth pattern (H&E, ×100). (D, E, F) AGC with mild FDG uptake (arrows) and diffuse growth pattern (H&E, ×100).

  • Fig. 2 Peritoneal seeding metastases with variable F-18 fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography. (A) Typical metastatic nodules with high FDG uptake (arrows) in the omentum. (B) Mild and diffuse FDG uptake (arrows) along the omentum.

  • Fig. 3 Changes in fluorodeoxyglucose (FDG) uptake of the primary tumors on positron emission tomography/computed tomography (PET/CT) to neoadjuvant chemotherapy. (A, B) PET responder, FDG uptake in the primary tumor showing more than 35% decreases in standardized uptake value (SUV) which is predictive of histopathological response and better patient survival. (C, D) PET non-responder, no remarkable changes in SUV in the primary tumor.


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