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Nuclear Medicine Communications:
doi: 10.1097/MNM.0000000000000170
Original Articles

Rifaximin suppresses background intestinal 18F-FDG uptake on PET/CT scans

Franquet, Elisaa,d; Palmer, Mathew R.a; Gifford, Anne E.b; Selen, Daryl J.a; Chen, Yih-Chieh S.a; Sedora-Roman, Nedaa; Joyce, Robin M.c; Kolodny, Gerald M.a,*; Moss, Alan C.b,*

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Abstract

Background: Identification of cancer or inflammatory bowel disease in the intestinal tract by PET/computed tomography (CT) imaging can be hampered by physiological uptake of 18F-fluorodeoxyglucose (18F-FDG) in the normal colon. Previous work has localized this 18F-FDG uptake to the intestinal lumen, predominantly occupied by bacteria. We sought to determine whether pretreatment with an antibiotic could reduce 18F-FDG uptake in the healthy colon.

Patients and methods: Thirty patients undergoing restaging PET/CT for nongastrointestinal lymphoma were randomly selected to receive rifaximin 550 mg twice daily for 2 days before their scan (post-rifaximin). Their PET/CT images were compared with those from their prior study (pre-rifaximin). Cecal maximum standard uptake value (SUVmax) and overall colonic 18F-FDG uptake were compared between scans. All PET/CT images were blindly scored by a radiologist. The same comparison of sequential scans was also undertaken in 30 patients who did not receive antibiotics.

Results: Thirty post-rifaximin scans were compared with 30 pre-rifaximin scans in the same patients. SUVmax in the cecum was significantly lower in the patient’s post-rifaximin scans than in their pre-rifaximin scans (P=0.002). The percentage of scans with greater than grade 1 colonic 18F-FDG uptake was significantly lower in the post-rifaximin scans than in the pre-rifaximin scans (P<0.05). In contrast, there was no significant difference in the paired sequential scans from control patients, nor a reduction in the percentage of scans with greater than grade 1 colonic 18F-FDG uptake.

Conclusion: This pilot study shows that treatment with rifaximin for 2 days before PET/CT scanning can significantly reduce physiological 18F-FDG uptake in the normal colonic lumen.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

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