Imaging description

In gastroesophageal reflux disease, the esophageal mucosa is subjected to chronic repetitive injury. The degree of inflammation is proportional to the frequency and duration of reflux events. Chronic reflux damage to the lower esophagus leads to replacement of the normal squamous cell lining with secretory columnar epithelium, which can withstand the erosive action of the gastric secretions. This metaplasia is termed Barrett's esophagus and confers an increased risk of adenocarcinoma. There is no relationship between the severity of reflux symptoms and the development of Barrett's esophagus. FDG uptake in distal esophageal inflammation, metaplasia, and early adenocarcinoma can be mild. Linear uptake is more common with benign causes of increased uptake (Figure 80.1) while focal and eccentric FDG uptake is associated with a higher rate of esophageal cancer at endoscopic biopsy (Figure 80.2) [1–3].

Importance

Reflux disease and Barrett's esophagus are common in the US and on PET/CT can resemble early esophageal malignancies. The challenge is to detect the incidental or synchronous esophageal carcinoma early while avoiding false positives from metaplasia and inflammation.