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Improving Evaluation of Primary Gastric Malignancies by Distending the Stomach with Milk Immediately Before ¹⁸F-FDG PET Scanning

¹ Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and ² Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Correspondence: For correspondence or reprints contact: Zhaohui Zhu, MD, Department of Nuclear Medicine, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing St., Dongcheng District, Beijing 100730, China. E-mail: zzh_1969{at}yahoo.com.cn or zhuzhh{at}pumch.cn

This study was designed to investigate the feasibility and effectiveness of a modified protocol for ¹⁸F-FDG PET that was proposed to improve the identification of primary gastric malignancies. Methods: In the modified protocol, patients were asked to drink 300–500 mL of cow milk to distend the stomach immediately before PET scans instead of fasting all along. For investigation of the influence of ingested milk on ¹⁸F-FDG distributions, 43 nondiabetic patients without documented gastric diseases underwent both empty- and distended-stomach PET scans (79 and 72 scans, respectively) in their serial follow-up studies. For the evaluation of proven gastric malignancies, 24 patients who underwent distended-stomach PET scans were compared with 17 patients who underwent conventional empty-stomach examinations. Results: Ingestion of milk nearly 1 h after ¹⁸F-FDG injection had no significant influence on distributions to the heart (P = 0.16), mediastinum (P = 0.50), and liver (P = 0.49), whereas the percentages of intense and moderate uptake in the stomach changed from 38.0% and 59.5% to 0% and 11.1%, respectively. With the normal gastric wall distended, malignant lesions were observed with higher contrast and clearer outlines, and some of them were detected at a small size (1.2 cm) at an early stage and with mild uptake. Conclusion: Gastric distention with milk just before ¹⁸F-FDG PET is a simple and effective method for improving the evaluation of primary gastric malignancies.

Key Words: PET; ¹⁸F-FDG; gastric malignancy; physiologic uptake; gastric distention