Acute Findings on FDG PET/CT: Key Imaging Features and How to Differentiate Them from Malignancy
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NUCLEAR MEDICINE & PET/CT IMAGING (R FLAVELL, SECTION EDITOR)
Acute Findings on FDG PET/CT: Key Imaging Features and How to Differentiate Them from Malignancy Yan Li1 • Spencer Behr1
Accepted: 31 August 2020 Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of review To review acute findings commonly encountered during routine clinical FDG PET/CT studies and present key imaging features to differentiate them from malignant counterparts. Recent findings FDG PET/CT is extensively used in routine clinical practice for oncology patients. Incidental acute findings in patients undergoing FDG PET/CT are increasingly common, and awareness of these findings and their mimics are important in delivering a clinically relevant and accurate radiological report for directing further management. Summary This article will review examples of common acute findings encountered during routine FDG PET/CT scans, compare them against examples of FDG-avid malignancy that can mimic these findings and emphasize key imaging findings to differentiate acute findings from their malignant mimics. Keywords FDG PET/CT Infection Inflammation Mimics Malignancy
This article is part of the Topical collection on Nuclear Medicine & PET/CT Imaging. & Spencer Behr [email protected] 1
Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
Introduction 18
F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a routinely performed imaging study in oncology patients. However, FDG uptake is not limited to neoplastic processes, as infections and inflammation can also result in focal FDG uptake, which may lead to false-positive results. Interpreting physicians must be aware of these potential pitfalls in order to avoid misdiagnosis. Patient history, concurrent CT finding, and knowledge of typical patterns of metastatic spread can guide interpretation of the abnormal FDG uptake. 18 F-FDG, a glucose analogue, has been used for the detection and evaluation of a wide range of solid and hematological malignancies due to the increased rate of glucose utilization in cancer cells. However, increased glucose uptake and utilization is not specific for malignant cells. Inflammatory cells such as neutrophils, activated macrophages, and lymphocytes also demonstrate increased 18 F- FDG accumulation through a shared mechanism [1, 2]. Therefore, infectious and inflammatory processes have the potential to be misinterpreted as metastatic disease. Metser et al. reviewed greater than one thousand 18F- FDG PET/ CTs and found one-quarter of these examinations contained incidental foci of benign FDG uptake [3]. The majority of these were related to infection and inflammation. Pneumonia, upper respiratory tract infections, and wound infections were among the most common etiologies identified incidentally on 18F-FDG PET/CT done for oncologic indications [4]. In addition, nu
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