• Ferdinando CalabriaEmail author
  • Andrea Cimini
  • Antonio Bagnato
  • Domenico Gullà
  • Giuseppe L. Cascini
  • Nicoletta Urbano
  • Orazio Schillaci


18F-FDG PET/CT is a widely used diagnostic tool in the management of oncologic diseases. Being an analog of glucose, the 18F-FDG uptake in cancer cells allows to detect growth and vitality during the time and distant metastases, in malignant tumors with high gradient of glucose metabolism. In these oncologic diseases, 18F-FDG is also currently useful as marker of response to therapy.

Moreover, the use of this tracer is not limited to oncology but is involved in the evaluation of brain metabolism in neurodegenerative diseases, also with hybrid, simultaneous, PET/MR imaging, and in the detection of myocardial viability by means of PET imaging.

The 18F-FDG follows, in vivo, the same biological pathway of glucose; after administration, it is taken up in cells with high glycolysis. Site of high rate of physiological uptake are the brain, myocardium, liver, spleen, and, due to renal excretion, kidneys, ureters, and bladder. During the time, several false positive cases have been described, due to the possibility of 18F-FDG uptake in inflammation, infections, and benign tumors. False negative cases can be due to malignant lesions with low rate of glucose metabolism.


18F-FDG PET/CT PET/MRI Neurology Oncology Hematology 





Blood oxygenation level dependent


Fluid attenuation inversion recovery


Maximum intensity projection


Magnetic resonance imaging


Positron emission tomography/computed tomography


Region of interest


Single photon emission computed tomography/computed tomography


Maximum standardized uptake value


  1. 1.
    Fowler JS, Ido T. Initial and subsequent approach for the synthesis of 18FDG. Semin Nucl Med. 2002;32:6–12.PubMedCrossRefGoogle Scholar
  2. 2.
    Hamacher K, Coenen HH, Stocklin G. Efficient stereospecific synthesis of no-carrier-added 2-[18F]-fluoro-2-deoxy-D-glucose using aminopolyether supported nucleophilic substitution. J Nucl Med. 1986;27:235–8.PubMedGoogle Scholar
  3. 3.
    Mochizuki T, Tsukamoto E, Kuge Y, et al. FDG uptake and glucose transporter subtype expressions in experimental tumor and inflammation models. J Nucl Med. 2001;42:1551–5.PubMedGoogle Scholar
  4. 4.
    Buck AK, Reske SN. Cellular origin and molecular mechanisms of 18F-FDG uptake: is there a contribution of the endothelium? J Nucl Med. 2004;45:461–3.PubMedGoogle Scholar
  5. 5.
    Sokoloff L, Reivich M, Kennedy C, et al. The [14C]deoxyglucose method for the measurement of local cerebral glucose utilization: theory, procedure, and normal values in the conscious and anesthetized albino rat. J Neurochem. 1977;28:897–916.PubMedCrossRefGoogle Scholar
  6. 6.
    Nguyen NC, Kaushik A, Wolverson MK, et al. Is there a common SUV threshold in oncological FDG PET/CT, at least for some common indications? A retrospective study. Acta Oncol. 2011;50:670–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Weber WA, Grosu AL, Czernin J. Technology insight: advances in molecular imaging and an appraisal of PET/CT scanning. Nat Clin Pract Oncol. 2008;5:160–70.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Kinahan PE, Fletcher JW. Positron emission tomography-computed tomography standardized uptake values in clinical practice and assessing response to therapy. Semin Ultrasound CT MR. 2010;31:496–505.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Schillaci O, Travascio L, Bolacchi F, et al. Accuracy of early and delayed FDG-PET/CT and of contrast enhanced CT in the evaluation of lung nodules: a preliminary study on 30 patients. Radiol Med. 2009;114:890–906.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Boellaard R, Delgado-Bolton R, Oyen WJ, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:238–354.CrossRefGoogle Scholar
  11. 11.
    Orlacchio A, Schillaci O, Antonelli L, et al. Solitary pulmonary nodules: morphological and metabolic characterization by FDG-PET-MDCT. Radiol Med. 2007;112:157–73.PubMedCrossRefGoogle Scholar
  12. 12.
    Bhure UN, Lardinois D, Kalff V, et al. Accuracy of CT parameters for assessment of tumour size and aggressiveness in lung adenocarcinoma with bronchoalveolar elements. Br J Radiol. 2010;89:841–9.CrossRefGoogle Scholar
  13. 13.
    Pavlidis N, Fizazi K. Carcinoma of unknown primary (CUP). Crit Rev Oncol Hematol. 2009;69:271–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Kwee TC, Basu S, Cheng G, et al. FDG PET/CT in carcinoma of unknown primary. Eur J Nucl Med Mol Imaging. 2010;37:635–44.PubMedCrossRefGoogle Scholar
  15. 15.
    Antoch G, Saoudi N, Kuehl H, et al. Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol. 2004;22:4357–68.PubMedCrossRefGoogle Scholar
  16. 16.
    Fernández-Pérez G, Sánchez-Escribano R, García-Vicente AM, et al. SEOM-SERAM-SEMNIM guidelines on the use of functional and molecular imaging techniques in advanced non-small-cell lung cancer. Clin Transl Oncol. 2018;20:837–52.PubMedCrossRefGoogle Scholar
  17. 17.
    Orsaria P, Chiaravalloti A, Caredda E, et al. Evaluation of the usefulness of FDG-PET/CT for nodal staging of breast cancer. Anticancer Res. 2018;38:6639–52.PubMedCrossRefGoogle Scholar
  18. 18.
    Macpherson RE, Pratap S, Tyrrell H, et al. Retrospective audit of 957 consecutive 18F-FDG PET-CT scans compared to CT and MRI in 493 patients with different histological subtypes of bone and soft tissue sarcoma. Clin Sarcoma Res. 2018;8:9.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Panebianco M, Bagni O, Cenfra N, et al. Comparison of 18F FDG PET-CT AND CECT in pretreatment staging of adults with Hodgkin’s lymphoma. Leuk Res. 2018;5:48–52.Google Scholar
  20. 20.
    Shim JR, Lee SD, Han SS, et al. Prognostic significance of 18F-FDG PET/CT in patients with colorectal cancer liver metastases after hepatectomy. Eur J Surg Oncol. 2018;44:670–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Narayanan P, Sahdev A. The role of 18F-FDG PET CT in common gynaecological malignancies. Br J Radiol. 2017;90:20170283.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Ronellenfitsch U, Wängler B, Niedermoser S, et al. Importance of PET for surgery of gastrointestinal stromal tumors. Chirurg. 2014;85:493–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Frary EC, Gad D, Bastholt T, et al. The role of FDG-PET/CT in preoperative staging of sentinel lymph node biopsy-positive melanoma patients. EJNMMI Res. 2016;6:73.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Guo W, Hao B, Chen H-j, et al. PET/CT-guided percutaneous biopsy of FDG-avid metastatic bone lesions in patients with advanced lung cancer: a safe and effective technique. Eur J Nucl Med Mol Imaging. 2017;44:25–32.PubMedCrossRefGoogle Scholar
  25. 25.
    Radhakrishnan RK, Mittal BR, Gorla AKR, et al. Real-time intraprocedural 18F-FDG PET/CT-guided biopsy using automated robopsy arm (ARA) in the diagnostic evaluation of thoracic lesions with prior inconclusive biopsy results: initial experience from a tertiary health care centre. Br J Radiol. 2017;90:20170258.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Chiaravalloti A, Fiorentini A, Palombo E, et al. Evaluation of recurrent disease in the re-staging of colorectal cancer by 18F-FDG PET/CT: use of CEA and CA 19-9 in patient selection. Oncol Lett. 2016;12:4209–13.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Soubra A, Gencturk M, Froelich J, et al. FDG-PET/CT for assessing the response to neoadjuvant chemotherapy in bladder cancer patients. Clin Genitourin Cancer. 2018;16:360–4.PubMedCrossRefGoogle Scholar
  28. 28.
    Findlay JM, Bradley KM, Wang LM, et al. Predicting pathologic response of esophageal cancer to neoadjuvant chemotherapy: the implications of metabolic nodal response for personalized therapy. J Nucl Med. 2017;58:266–75.PubMedCrossRefGoogle Scholar
  29. 29.
    Kitajima K, Yamamoto S, Fukushima K, et al. FDG-PET/CT as a post-treatment restaging tool in urothelial carcinoma: comparison with contrast-enhanced CT. Eur J Radiol. 2016;85:593–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Wahl RL, Jacene H, Kasamon Y, et al. From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med. 2009;50:122s–50s.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Rigacci L, Puccini B, Zinzani PL, et al. The prognostic value of positron emission tomography performed after two courses (INTERIM-PET) of standard therapy on treatment outcome in early stage Hodgkin lymphoma: a multicentric study by the fondazione italiana linfomi (FIL). Am J Hematol. 2015;90:499–503.PubMedCrossRefGoogle Scholar
  32. 32.
    Rudžianskas V, Korobeinikova E, Rudžianskienė M, et al. Use of 18F-FDG PET/CT imaging for radiotherapy target volume delineation after induction chemotherapy and for prognosis of locally advanced squamous cell carcinoma of the head and neck. Medicina (Kaunas). 2018;10:6.Google Scholar
  33. 33.
    Lee P, Kupelian P, Czernin J, et al. Current concepts in F18 FDG PET/CT-based radiation therapy planning for lung cancer. Front Oncol. 2012;11:71.Google Scholar
  34. 34.
    Moule RN, Kayani I, Moinuddin SA, et al. The potential advantages of (18)FDG PET/CT-based target volume delineation in radiotherapy planning of head and neck cancer. Radiother Oncol. 2010;97:189–93.PubMedCrossRefGoogle Scholar
  35. 35.
    Muijs CT, Beukema JC, Pruim J, et al. A systematic review on the role of FDG-PET/CT in tumour delineation and radiotherapy planning in patients with esophageal cancer. Radiother Oncol. 2010;97:165–71.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Nguyen BT, Joon DL, Khoo V, et al. Assessing the impact of FDG-PET in the management of anal cancer. Radiother Oncol. 2008;87:376–82.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Vaidyanathan S, Patel CN, Scarsbrook AF, et al. FDG PET/CT in infection and inflammation--current and emerging clinical applications. Clin Radiol. 2015;70:787–800.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Filippi L, Uccioli L, Giurato L, et al. Diabetic foot infection: usefulness of SPECT/CT for 99mTc-HMPAO-labeled leukocyte imaging. J Nucl Med. 2009;50:1042–6.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Petruzzi N, Shanthly N, Thakur M. Recent trends in soft-tissue infection imaging. Semin Nucl Med. 2009;39:115–23.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Rastogi A, Bhattacharya A, Prakash M, et al. Utility of PET/CT with fluorine-18-fluorodeoxyglucose-labeled autologous leukocytes for diagnosing diabetic foot osteomyelitis in patients with Charcot’s neuroarthropathy. Nucl Med Commun. 2016;37:1253–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Kobayashi Y, Ishii K, Oda K, et al. Aortic wall inflammation due to Takayasu arteritis imaged with 18F-FDG PET coregistered with enhanced CT. J Nucl Med. 2005;46:917–22.PubMedGoogle Scholar
  42. 42.
    Slart RHJA; Writing group; Reviewer group; Members of EANM Cardiovascular; Members of EANM Infection & Inflammation; Members of Committees, SNMMI Cardiovascular, et al. FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. Eur J Nucl Med Mol Imaging. 2018;45:1250–69.CrossRefGoogle Scholar
  43. 43.
    Palatka K, Kacska S, Lovas S, et al. The potential role of FDG PET-CT in the characterization of the activity of Crohn’s disease, staging follow-up and prognosis estimation: a pilot study. Scand J Gastroenterol. 2018;53:24–30.PubMedCrossRefGoogle Scholar
  44. 44.
    Berry N, Sinha SK, Bhattacharya A, et al. Role of positron emission tomography in assessing disease activity in ulcerative colitis: comparison with biomarkers. Dig Dis Sci. 2018;63:1541–50.PubMedCrossRefGoogle Scholar
  45. 45.
    Ankrah AO, Span LFR, Klein HC, et al. Role of FDG PET/CT in monitoring treatment response in patients with invasive fungal infections. Eur J Nucl Med Mol Imaging. 2019;46:174–83.PubMedCrossRefGoogle Scholar
  46. 46.
    Leroy-Freschini B, Treglia G, Argemi X, et al. 18F-FDG PET/CT for invasive fungal infection in immunocompromised patients. QJM. 2018;111:613–22.PubMedCrossRefGoogle Scholar
  47. 47.
    Sathekge M, Maes A, Van de Wiele C. FDG-PET imaging in HIV infection and tuberculosis. Semin Nucl Med. 2013;43:349–66.PubMedCrossRefGoogle Scholar
  48. 48.
    Akaike G, Itani M, Shah H, et al. PET/CT in the diagnosis and workup of sarcoidosis: focus on atypical manifestations. Radiographics. 2018;38:1536–49.PubMedCrossRefGoogle Scholar
  49. 49.
    Imperiale A, Riehm S, Braun JJ. Interest of [18F]FDG PET/CT for treatment efficacy assessment in aggressive phenotype of sarcoidosis with special emphasis on sinonasal involvement. Q J Nucl Med Mol Imaging. 2013;57:177–86.PubMedGoogle Scholar
  50. 50.
    Calabria FF, Calabria E, Gangemi V, et al. Current status and future challenges of brain imaging with 18F-DOPA PET for movement disorders. Hell J Nucl Med. 2016;19:33–41.PubMedGoogle Scholar
  51. 51.
    Garraux G, Phillips C, Schrouff J, et al. Multiclass classification of FDG PET scans for the distinction between Parkinson’s disease and atypical parkinsonian syndromes. Neuroimage Clin. 2013;14:883–93.CrossRefGoogle Scholar
  52. 52.
    Yoon RG, Kim SJ, Kim HS, et al. The utility of susceptibility-weighted imaging for differentiating Parkinsonism-predominant multiple system atrophy from Parkinson’s disease: correlation with 18F-flurodeoxyglucose positron-emission tomography. Neurosci Lett. 2015;1:296–301.CrossRefGoogle Scholar
  53. 53.
    Meltzer CC, Adelson PD, Brenner RP, et al. Planned ictal FDG PET imaging for localization of extratemporal epileptic foci. Epilepsia. 2000;41:193–200.PubMedCrossRefGoogle Scholar
  54. 54.
    Morbelli S, Djekidel M, Hesse S, et al. Role of (18)F-FDG-PET imaging in the diagnosis of autoimmune encephalitis. Lancet Neurol. 2016;15:1009–10.PubMedCrossRefGoogle Scholar
  55. 55.
    van Hamersvelt HP, Kwee TC, Fijnheer R, et al. Can full-dose contrast-enhanced CT be omitted from an FDG-PET/CT staging examination in newly diagnosed FDG-avid lymphoma? J Comput Assist Tomogr. 2014;38:620–5.PubMedCrossRefGoogle Scholar
  56. 56.
    Rosenkrantz AB, Friedman K, Chandarana H, et al. Current status of hybrid PET/MRI in oncologic imaging. AJR Am J Roentgenol. 2016;206:162–72.PubMedCrossRefGoogle Scholar
  57. 57.
    Ferda J, Ferdová E, Baxa J, et al. 18F-Fluorocholine PET/MRI in restaging of prostatic carcinoma in relation to PSA level and detection of active disease. Anticancer Res. 2018;38:4139–43.PubMedCrossRefGoogle Scholar
  58. 58.
    Leiva-Salinas C, Muttikkal TJE, Flors L, et al. FDG PET/MRI Coregistration helps predict response to gamma knife radiosurgery in patients with brain metastases. AJR Am J Roentgenol. 2018;13:1–6.Google Scholar
  59. 59.
    Seniaray N, Jain A. PET MRI Coregistration in intractable epilepsy and gray matter heterotopia. Clin Nucl Med. 2017;42:e171–2.PubMedCrossRefGoogle Scholar
  60. 60.
    Barthel H, Schroeter ML, Hoffmann KT, et al. PET/MR in dementia and other neurodegenerative diseases. Semin Nucl Med. 2015;45:224–33.PubMedCrossRefGoogle Scholar
  61. 61.
    Corrigan AJ, Schleyer PJ, Cook GJ. Pitfalls and artifacts in the use of PET/CT in oncology imaging. Semin Nucl Med. 2015;45:481–99.PubMedCrossRefGoogle Scholar
  62. 62.
    Vandemoortele T, Laroumagne S, Roca E, et al. Positive FDG-PET/CT of the pleura twenty years after talc pleurodesis: three cases of benign talcoma. Respiration. 2014;87:243–8.PubMedCrossRefGoogle Scholar
  63. 63.
    Purohit BS, Ailianou A, Dulguerov N, et al. FDG-PET/CT pitfalls in oncological head and neck imaging. Insights Imaging. 2014;5:585–602.PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Priola AM, Priola SM. Chemical-shift MRI of rebound thymic hyperplasia with unusual appearance and intense (18)F-FDG uptake in adulthood: report of two cases. Clin Imaging. 2014;38:739–42.PubMedCrossRefGoogle Scholar
  65. 65.
    Martínez Lorca A, Coronado Poggio M, Hernández Pérez I, et al. Utility of (99m)Tc-labelled heat-denatured erythrocyte scintigraphy and 18F-FDG PET-CT to differentiate accessory spleens from tumoral metastases. A case report. Rev Esp Med Nucl Imagen Mol. 2015;34:68–9.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ferdinando Calabria
    • 1
    Email author
  • Andrea Cimini
    • 2
  • Antonio Bagnato
    • 1
  • Domenico Gullà
    • 3
  • Giuseppe L. Cascini
    • 4
  • Nicoletta Urbano
    • 5
  • Orazio Schillaci
    • 6
    • 7
  1. 1.Department of Nuclear Medicine and Theranostics“Mariano Santo” HospitalCosenzaItaly
  2. 2.Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and RadiotherapyUniversity Hospital Tor VergataRomeItaly
  3. 3.Neuroimaging PET/MRI Research UnitInstitute of Molecular Bioimaging and Physiology, Italian National Research Council, IBFM-CNRCatanzaroItaly
  4. 4.Nuclear Medicine Unit, Department of Diagnostic ImagingMagna Graecia UniversityCatanzaroItaly
  5. 5.Nuclear Medicine UnitUniversity Hospital “Tor Vergata”RomeItaly
  6. 6.Department of Biomedicine and PreventionUniversity “Tor Vergata”RomeItaly
  7. 7.Department of Nuclear Medicine and Molecular ImagingIRCCS NeuromedPozzilliItaly

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