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18F-FDG PET/CT: Normal Variants, Artifacts, and Pitfalls in Lung Cancer

  • Archi AgrawalEmail author
  • Venkatesh Rangarajan
Chapter
  • 775 Downloads
Part of the Clinicians’ Guides to Radionuclide Hybrid Imaging book series (CGRHI)

Abstract

18F-2-Fluoro-2-deoxyglucose (FDG) is the workhorse of oncological PET/CT departments. Its role in staging, restaging, and response assessment of various cancers is already established. But FDG is a marker of glycolysis and, thus, is neither specific for malignancy nor for a particular tumor. Its accumulation can be seen in benign process which may be difficult to differentiate from a neoplastic etiology. It is imperative that nuclear physicians and radiologists know about these FDG-avid benign pathologies and few FDG-negative malignant etiologies, which may confound correct interpretation in PET/CT reporting.

References

  1. 1.
    Beyer T, Antoch G, Blodgett T, et al. Dual-modality PET/CT imaging: the effect of respiratory motion on combined image quality in clinical oncology. Eur J Nucl Med Mol Imaging. 2003;30:588–96.CrossRefPubMedGoogle Scholar
  2. 2.
    Nehmeh SA, Erdi YE, Kalaigian H, et al. Correction for oral contrast artifacts in CT attenuation corrected PET images obtained by combined PET/CT. J Nucl Med. 2003;44:1940–4.PubMedGoogle Scholar
  3. 3.
    Liu Y, Ghesani NV, Zuckier LS. Physiology and pathophysiology of incidental findings detected on FDG-PET scintigraphy. Semin Nucl Med. 2010;40(4):294–315.CrossRefPubMedGoogle Scholar
  4. 4.
    Farsad M, Ambrosini V, Nanni C, et al. Focal lung uptake of 18F-fluorodeoxyglucose (18F-FDG) without computed tomography findings. Nucl Med Commun. 2005;26(9):827–30.CrossRefPubMedGoogle Scholar
  5. 5.
    Ozdemir E, Poyraz NY, Keskin M, Kandemir Z, Turkolmez S. Hot-clot artifacts in the lung parenchyma on F-18 fluorodeoxyglucose positron emission tomography/CT due to faulty injection techniques: two case reports. Korean J Radiol. 2014;15(4):530–3.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Kubota R, Yamada S, Kubota K, et al. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med. 1992;33:1972–80.PubMedGoogle Scholar
  7. 7.
    Paik JY, Lee KH, Choe YS, et al. Augmented 18F-FDG uptake in activated monocytes occurs during the priming process and involves tyrosine kinases and protein kinase C. J Nucl Med. 2004;45:124–8.PubMedGoogle Scholar
  8. 8.
    Bakheet SM, Powe J, Ezzat A, et al. F-18-FDG uptake in tuberculosis. Clin Nucl Med. 1998;23:739–42.CrossRefPubMedGoogle Scholar
  9. 9.
    Skoura E, Zumla A, Bomanji J. Imaging in tuberculosis. Int J Infect Dis. 2015;32:87–93.CrossRefPubMedGoogle Scholar
  10. 10.
    Lewis PJ, Salama A. Uptake of fluorine-18-deoxyglucose uptake in sarcoidosis. J Nucl Med. 1994;35:1647–9.PubMedGoogle Scholar
  11. 11.
    Yasuda S, Shothsu A, Ide M, et al. High fluorine-18-deoxyglucose uptake in sarcoidosis. Clin Nucl Med. 1996;21:983–4.CrossRefPubMedGoogle Scholar
  12. 12.
    El-Haddad G, Zhuang H, Gupta N, et al. Evolving role of positron emission tomography in the management of patients with inflammatory and other benign disorders. Semin Nucl Med. 2004;34(4):313–29.CrossRefPubMedGoogle Scholar
  13. 13.
    Sobic-Saranovic D, Artiko V, Obradovic V. FDG PET imaging in sarcoidosis. Semin Nucl Med. 2013;43(6):404–11.CrossRefPubMedGoogle Scholar
  14. 14.
    Quan XQ, Yin TJ, Zhang CT, Liu J, Qiao LF, Ke CS. (18)F-FDG PET/CT in patients with nodular pulmonary amyloidosis: case report and literature review. Case Rep Oncol. 2014;7(3):789–98.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Wachsmann JW, Gerbaudo VH. Thorax: normal and benign pathologic patterns in FDG-PET/CT imaging. PET Clin. 2014;9(2):147–68.CrossRefPubMedGoogle Scholar
  16. 16.
    Kwek BH, Aquino SL, Fischman AJ. Fluorodeoxyglucose positron emission tomography and CT after talc pleurodesis. Chest. 2004;125:2356–60.CrossRefPubMedGoogle Scholar
  17. 17.
    Ahmadzadehfar H, Palmedo H, Strunk H, Biersack HJ, Habibi E, Ezziddin S. False positive 18F-FDG-PET/CT in a patient after talc pleurodesis. Lung Cancer. 2007;58(3):418–21.CrossRefPubMedGoogle Scholar
  18. 18.
    Ulaner GA, Lyall A. Identifying and distinguishing treatment effects and complications from malignancy at FDG PET/CT. Radiographics. 2013;33(6):1817–34.CrossRefPubMedGoogle Scholar
  19. 19.
    de Prost N, Tucci MR, Melo MF. Assessment of lung inflammation with 18F-FDG PET during acute lung injury. AJR Am J Roentgenol. 2010;195(2):292–300.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Kamel EM, Goerres GW, Burger C, et al. Recurrent laryngeal nerve palsy in patients with lung cancer: detection with PET/CT image fusion—report of six cases. Radiology. 2002;224:153–6.Google Scholar
  21. 21.
    Lee M, Ramaswamy MR, Lilien DL, et al. Unilateral vocal cord paralysis causes contralateral false-positive positron emission tomography scans of the larynx. Ann Otol Rhinol Laryngol. 2005;114:202–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Peter Klussmen J, Wittekindt C, Florian Preuss S, et al. High risk for bilateral warthin tumor in heavy smokers - review of 185 cases. Acta Otolaryngol. 2006;126:1213–7.CrossRefGoogle Scholar
  23. 23.
    Lee SK, Rho BH, Won KS. Parotid incidentaloma identified by combined 18F-fluorodeoxyglucose whole-body positron emission tomography and computed tomography: findings at gray-scale and power Doppler ultrasonography and ultrasound-guided fine-needle aspiration biopsy or core biopsy. Eur Radiol. 2009;19:2268–74.CrossRefPubMedGoogle Scholar
  24. 24.
    Inoue K, Okada K, Harigae H, et al. Diffuse bone marrow uptake on F-18 FDG PET in patients with myelodysplastic syndromes. Clin Nucl Med. 2006;31:721–3.CrossRefPubMedGoogle Scholar
  25. 25.
    Higashi K, Ueda Y, Sakurai A, et al. Correlation of Glut-1 glucose transporter expression with [18F]FDG uptake in non-small cell lung cancer. Eur J Nucl Med. 2000;27:1778–85.CrossRefGoogle Scholar
  26. 26.
    Stefani A, Franceschetto A, Nesci J, Aramini B, Proli C, Kaleci S, et al. Integrated FDG-PET/CT imaging is useful in the approach to carcinoid tumors of the lung. J Cardiothorac Surg. 2013;8:223.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Nomori H, Watanabe K, Ohtsuka T, et al. Evaluation of F-18 fluorodeoxyglucose (FDG) PET scanning for pulmonary nodules less than 3 cm in diameter, with special reference to the CT images. Lung Cancer. 2004;45:19–27.CrossRefPubMedGoogle Scholar
  28. 28.
    Cook GJ, Wegner EA, Fogelman I. Pitfalls and artifacts in 18FDG PET and PET/CT oncologic imaging. Semin Nucl Med. 2004;34(2):122–33.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Nuclear Medicine and Molecular ImagingTata Memorial HospitalMumbaiIndia

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