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Background  Focal colorectal uptake in  18 FDG-PET/CT may be associated with a malignancy and can be quantified. This provides the basis for an automatic trigger threshold above which cases are flagged for colonoscopic evaluation and below which for individual assessment.    Purpose  To determine the lowest maximum standard uptake (SUV max ) in colorectal cancer that could be used as a threshold to trigger endoscopic evaluation and to evaluate whether the SUV max  needs to be further normalised to a priori known extrinsic factors.    Methods  The SUV max  was measured in 54 colorectal carcinomas and correlated with gender, age, blood glucose level, injected activity, body mass index and time to scan using  t  test or correlation coefficients (Pearson or Spearman, according to distribution).    Results  There was no correlation between SUV max  and any of the extrinsic factors mentioned above. The lowest SUV max  value was 5 [mean ± SD (range): 11.1 ± 4.8 (5.0–24.6)].    Conclusion  In contrast to most other screening techniques, semi-automation in colorectal screening seems possible with PET/CT. This opens the door for further study into the feasibility of automated screening. Independent from extrinsic factors, an SUV max  ≥5.0 in a focal colorectal uptake in  18 FDG-PET/CT should automatically trigger for endoscopic evaluation, if not contraindicated. Cases with SUV max  <5 should be assessed individually before referral for endoscopy. Thus, more interpretation time could be spent on those cases with a lower uptake and more ambiguous diagnosis.    Electronic supplementary material  The online version of this article (doi:10.1186/s40001-016-0195-z) contains supplementary material, which is available to authorized users.

Focal colorectal uptake in 18FDG-PET/CT: maximum standard uptake value as a trigger in a semi-automated screening setting