18F-FDG PET/CT Imaging: Normal Variants, Pitfalls and Artefacts

  • Kanhaiyalal AgrawalEmail author
  • Gopinath Gnanasegaran
  • Evangelia Skoura
  • Alexis Corrigan
  • Teresa A. Szyszko
Part of the Clinicians’ Guides to Radionuclide Hybrid Imaging book series (CGRHI)


In recent years, positron emission tomography (PET)/computed tomography (CT) has gained widespread clinical acceptance in oncology. It is being used extensively in the diagnosis, staging, restaging and therapy response evaluation of tumours along with several benign indications in cardiology and neurology. Fluorine-18 (18F) 2-fluoro-2-deoxy-D-glucose (FDG) is the most commonly used positron-emitting radiotracer in PET/CT studies. In this chapter, we will mainly focus on normal variants and artefacts in 18F-FDG PET/CT studies.


Positron Emission Tomography Attenuation Correction Positron Emission Tomography Data Physiological Tracer Positron Emission Tomography Image Acquisition 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Thanks to Dr. Nerriman, Dr. Riyamma and Dr. Halsey for contributing images for the chapter on “PET/CT Imaging: Normal variants, Pitfalls and Artefacts”.


  1. 1.
    Agrawal K, Mittal BR, Bansal D, et al. Role of F-18 FDG PET/CT in assessing bone marrow involvement in pediatric Hodgkin’s lymphoma. Ann Nucl Med. 2013;27(2):146–51.CrossRefPubMedGoogle Scholar
  2. 2.
    Mittal BR, Agrawal K. FDG-PET in tuberculosis. Curr Mol Imaging. 2014;3(3):211–5.CrossRefGoogle Scholar
  3. 3.
    Cook GJR, Fogelman I, Maisey MN. Normal physiological and benign pathological variants of 18F-FDG PET scanning: potential for error in interpretation. Semin Nucl Med. 1996;26:308–14.CrossRefPubMedGoogle Scholar
  4. 4.
    Cook GJR, Maisey MN, Fogelman I. Normal variants, artefacts and interpretative pitfalls in PET imaging with 18F-fluoro-2-deoxyglucose and carbon-11 methionine. Eur J Nucl Med. 1999;26:1363–78.CrossRefPubMedGoogle Scholar
  5. 5.
    Cook GJ, Wegner EA, Fogelman I. Pitfalls and artifacts in 18FDG PET and PET/CT oncologic imaging. Semin Nucl Med. 2004;34:122–33.CrossRefPubMedGoogle Scholar
  6. 6.
    Culverwell AD, Scarsbrook AF, Chowdhury FU. False-positive uptake on 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography/computed tomography (PET/CT) in oncological imaging. Clin Radiol. 2011;66:366–82.CrossRefPubMedGoogle Scholar
  7. 7.
    Shreve PD, Anzai Y, Wahl RL. Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants. Radiographics. 1999;19:61–77.CrossRefPubMedGoogle Scholar
  8. 8.
    Delbeke D, Coleman RE, Guiberteau MJ, et al. Procedure guideline for tumour imaging with 18F-FDG PET/CT 1.0. J Nucl Med. 2006;47:885–95.PubMedGoogle Scholar
  9. 9.
    Boellaard R, O’Doherty MJ, Weber WA, et al. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging. 2010;37:181–200.CrossRefPubMedGoogle Scholar
  10. 10.
    Segall G, Delbeke D, Stabin MG, et al. SNM practice guideline for sodium 18F-fluoride PET/CT bone scans 1.0. J Nucl Med. 2010;51:1813–20.CrossRefPubMedGoogle Scholar
  11. 11.
    Juweid ME, Cheson BD. Positron-emission tomography and assessment of cancer therapy. N Engl J Med. 2006;354:496–507.CrossRefPubMedGoogle Scholar
  12. 12.
    Gorospe L, Raman S, Echeveste J, et al. Whole-body PET/CT: spectrum of physiological variants, artifacts and interpretative pitfalls in cancer patients. Nucl Med Commun. 2005;26:671–87.CrossRefPubMedGoogle Scholar
  13. 13.
    Shammas A, Lim R, Charron M. Pediatric FDG PET/CT: physiologic uptake, normal variants, and benign conditions. Radiographics. 2009;29:1467–86.CrossRefPubMedGoogle Scholar
  14. 14.
    Harisankar CN, Mittal BR, Agrawal KL, et al. Utility of high fat and low carbohydrate diet in suppressing myocardial FDG uptake. J Nucl Cardiol. 2011;18:926–36.CrossRefPubMedGoogle Scholar
  15. 15.
    Agrawal K, Weaver J, Ngu R, et al. Clinical significance of patterns of incidental thyroid uptake at (18)F-FDG PET/CT. Clin Radiol. 2015;70(5):536–43.CrossRefPubMedGoogle Scholar
  16. 16.
    Corrigan AJ, Schleyer PJ, Cook GJ. Pitfalls and artifacts in the use of PET/CT in oncology imaging. Semin Nucl Med. 2015;45(6):481–99.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Kanhaiyalal Agrawal
    • 1
    Email author
  • Gopinath Gnanasegaran
    • 2
  • Evangelia Skoura
    • 3
  • Alexis Corrigan
    • 4
  • Teresa A. Szyszko
    • 5
  1. 1.Department of Nuclear Medicine and PET/CTNorth City HospitalKolkataIndia
  2. 2.Department of Nuclear MedicineRoyal Free London NHS Foundation TrustLondonUK
  3. 3.Institute of Nuclear Medicine, UCLHLondonUK
  4. 4.Department of Nuclear Medicine and RadiologyMaidstone and Tunbridge Wells NHS TrustTunbridge WellsUK
  5. 5.King’s College and Guy’s and St Thomas’ PET Centre, Division of Imaging Sciences and Biomedical EngineeringKings College London, St Thomas’ HospitalLondonUK

Personalised recommendations