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Abdominal Radiology

23-04-2024 | Computed Tomography | Review

Overview of F18-FDG uptake patterns in retroperitoneal pathologies: imaging findings, pitfalls, and artifacts

Authors: Priya Pathak, Laith Abandeh, Hassan Aboughalia, Atefe Pooyan, Bahar Mansoori

Published in: Abdominal Radiology

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Abstract

Introduction

Retroperitoneum can be the origin of a wide variety of pathologic conditions and potential space for disease spread to other compartments of the abdomen and pelvis. Computed tomography (CT) and magnetic resonance imaging (MRI) are often the initial imaging modalities to evaluate the retroperitoneal pathologies, however given the intrinsic limitations, F18-FDG PET/CT provides additional valuable metabolic information which can change the patient management and clinical outcomes. We highlight the features of retroperitoneal pathologies on F18-FDG PET/CT and the commonly encountered imaging artifacts and pitfalls. The aim of this review is to characterize primary and secondary retroperitoneal pathologies based on their metabolic features, and correlate PET findings with anatomic imaging.

Conclusion

Retroperitoneal pathologies can be complex, ranging from oncologic to a spectrum of non-oncologic disorders. While crosse-sectional imaging (CT and MRI) are often the initial imaging modalities to localize and characterize pathologies, metabolic information provided by F18-FDG PET/CT can change the management and clinical outcome in many cases.

Graphical abstract

(a) Brown fat activation on F18-FDG PET. Axial fused PET image of the abdomen shows hypermetabolic foci in the bilateral perinephric fat (arrows). (b) Adrenal metastasis in a 78-year-old woman with serous ovarian carcinoma. Axial fused PET/CT of the abdomen shows intense uptake in the new left adrenal lesion (arrow), with FDG uptake intensity markedly higher than the liver. (c)Axial contrast-enhanced CT abdomen shows the lobulated mildly enhancing left adrenal metastasis (circle).
Literature
1.
Osman, S., et al., A comprehensive review of the retroperitoneal anatomy, neoplasms, and pattern of disease spread. Curr Probl Diagn Radiol, 2013. 42(5): p. 191-208.PubMedCrossRef
2.
Ziessman, H.A., et al., Preface, in Nuclear Medicine (Fourth Edition), H.A. Ziessman, J.P. O’Malley, and J.H. Thrall, Editors. 2014, W.B. Saunders: Philadelphia. p. ix.CrossRef
3.
4.
Tirkes, T., et al., Peritoneal and retroperitoneal anatomy and its relevance for cross-sectional imaging. Radiographics, 2012. 32(2): p. 437-51.PubMedCrossRef
5.
Boellaard, R., et al., FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging, 2015. 42(2): p. 328-54.PubMedCrossRef
6.
Delbeke, D., et al., Procedure guideline for tumor imaging with 18F-FDG PET/CT 1.0. J Nucl Med, 2006. 47(5): p. 885-95.PubMed
7.
Fahim Ul, H. and G.J. Cook, PET/CT in oncology. Clin Med (Lond), 2012. 12(4): p. 368-72.
8.
Vesselle, H.J. and F.D. Miraldi, FDG PET of the retroperitoneum: normal anatomy, variants, pathologic conditions, and strategies to avoid diagnostic pitfalls. Radiographics, 1998. 18(4): p. 805-23; discussion 823-4.PubMedCrossRef
9.
Lakhani, A., et al., FDG PET/CT Pitfalls in Gynecologic and Genitourinary Oncologic Imaging. Radiographics, 2017. 37(2): p. 577-594.PubMedCrossRef
10.
11.
Schreuder, N., et al., Discontinuation of metformin to prevent metformin-induced high colonic FDG uptake: is 48 h sufficient? Ann Nucl Med, 2020. 34(11): p. 833-839.PubMedPubMedCentralCrossRef
12.
Caiafa, R.O., et al., Retroperitoneal fibrosis: role of imaging in diagnosis and follow-up. Radiographics, 2013. 33(2): p. 535-52.PubMedCrossRef
13.
Scheel, P.J., Jr. and N. Feeley, Retroperitoneal fibrosis. Rheum Dis Clin North Am, 2013. 39(2): p. 365-81.PubMedCrossRef
14.
Brandt, A.S., et al., Associated findings and complications of retroperitoneal fibrosis in 204 patients: results of a urological registry. J Urol, 2011. 185(2): p. 526-31.PubMedCrossRef
15.
Cronin, C.G., et al., Retroperitoneal fibrosis: a review of clinical features and imaging findings. AJR Am J Roentgenol, 2008. 191(2): p. 423-31.PubMedCrossRef
16.
Jansen, I., et al., (18)F-fluorodeoxyglucose position emission tomography (FDG-PET) for monitoring disease activity and treatment response in idiopathic retroperitoneal fibrosis. Eur J Intern Med, 2010. 21(3): p. 216-21.PubMedCrossRef
17.
Angelina, C., et al., 18F-FDG PET/CT in management of retroperitoneal fibrosis: A promising tool. Journal of Nuclear Medicine, 2012. 53(supplement 1): p. 2145.
18.
Moroni, G., et al., The value of (18)F-FDG PET/CT in the assessment of active idiopathic retroperitoneal fibrosis. Eur J Nucl Med Mol Imaging, 2012. 39(10): p. 1635-42.PubMedCrossRef
19.
Polo-Sabau, J. and B. López-Botet-Zulueta, Massive Perirenal Involvement in Erdheim-Chester Disease. Radiology, 2021. 301(2): p. 278-278.PubMedCrossRef
20.
Nikpanah, M., et al., (2019) Pictorial Review of the 18F-FDG PET/CT Manifestations of Erdheim-Chester Disease. Vol. 60: 1141–1141.
21.
Young, J.R., et al., (18)F-FDG PET/CT in Erdheim-Chester Disease: Imaging Findings and Potential BRAF Mutation Biomarker. J Nucl Med, 2018. 59(5): p. 774-779.PubMedCrossRef
22.
Kirchner, J., et al., (18)F-FDG PET/CT versus anatomic imaging for evaluating disease extent and clinical trial eligibility in Erdheim-Chester disease: results from 50 patients in a registry study. Eur J Nucl Med Mol Imaging, 2021. 48(4): p. 1154-1165.PubMedCrossRef
23.
Qiu, D., et al., Extramedullary hematopoiesis on 18F-FDG PET/CT in a patient with thalassemia and nasopharyngeal carcinoma: A case report and literature review. J Cancer Res Ther, 2015. 11(4): p. 1034.PubMedCrossRef
24.
Dahlsgaard-Wallenius, S.E., et al., Extramedullary Hematopoiesis Visualized on FDG-PET/CT in a Patient with Beta-Thalassemia. Nuclear Medicine and Molecular Imaging, 2022. 56(6): p. 328-330.PubMedPubMedCentralCrossRef
25.
26.
Han, E.J., et al., FDG PET/CT Findings of Castleman Disease Assessed by Histologic Subtypes and Compared with Laboratory Findings. Diagnostics (Basel), 2020. 10(12).CrossRefPubMed
27.
Jiang, Y., et al., The value of multiparameter 18F-FDG PET/CT imaging in differentiating retroperitoneal paragangliomas from unicentric Castleman disease. Scientific Reports, 2020. 10(1): p. 12887.PubMedPubMedCentralCrossRef
28.
Messiou, C. and C. Morosi, Imaging in retroperitoneal soft tissue sarcoma. J Surg Oncol, 2018. 117(1): p. 25-32.PubMedCrossRef
29.
Kransdorf, M.J., et al., Imaging of fatty tumors: distinction of lipoma and well-differentiated liposarcoma. Radiology, 2002. 224(1): p. 99-104.PubMedCrossRef
30.
Nina, Z., et al., <strong>The PET/CT manifestations of different pathological subtypes of retroperitoneal liposarcoma</strong&gt. Journal of Nuclear Medicine, 2018. 59(supplement 1): p. 128.
31.
Subramaniam, S., et al., The role of (18) F-FDG PET/CT in retroperitoneal sarcomas-A multicenter retrospective study. J Surg Oncol, 2021. 123(4): p. 1081-1087.PubMedCrossRef
32.
Rajiah, P., et al., Imaging of uncommon retroperitoneal masses. Radiographics, 2011. 31(4): p. 949-76.PubMedCrossRef
33.
Beaulieu, S., et al., Positron emission tomography of schwannomas: emphasizing its potential in preoperative planning. AJR Am J Roentgenol, 2004. 182(4): p. 971-4.PubMedCrossRef
34.
Bredella, M.A., et al., Value of PET in the assessment of patients with neurofibromatosis type 1. AJR Am J Roentgenol, 2007. 189(4): p. 928-35.PubMedCrossRef
35.
Chirindel, A., et al., 18F-FDG PET/CT qualitative and quantitative evaluation in neurofibromatosis type 1 patients for detection of malignant transformation: comparison of early to delayed imaging with and without liver activity normalization. J Nucl Med, 2015. 56(3): p. 379-85.PubMedCrossRef
36.
Tovmassian, D., M. Abdul Razak, and K. London, The Role of [(18)F]FDG-PET/CT in Predicting Malignant Transformation of Plexiform Neurofibromas in Neurofibromatosis-1. Int J Surg Oncol, 2016. 2016: p. 6162182.PubMedPubMedCentral
37.
Geitenbeek, R.T.J., et al., Diagnostic value of (18)F-FDG PET-CT in detecting malignant peripheral nerve sheath tumors among adult and pediatric neurofibromatosis type 1 patients. J Neurooncol, 2022. 156(3): p. 559-567.PubMedPubMedCentralCrossRef
38.
39.
Hung, T.J., et al., The role of (18)F-FDG-PET/CT in evaluating retroperitoneal masses -Keeping your eye on the ball! Cancer Imaging, 2019. 19(1): p. 28.PubMedPubMedCentralCrossRef
40.
Sharma, P., et al., Diagnostic accuracy of integrated (18)F-FDG PET/CT for restaging patients with malignant germ cell tumours. Br J Radiol, 2014. 87(1040): p. 20140263.PubMedPubMedCentralCrossRef
41.
Si-Long, H., et al., 18F-FDG PET/CT in the evaluation of testicular nonseminomatous germ cell cancer after orchiectomy and chemotherapy. Journal of Nuclear Medicine, 2013. 54(supplement 2): p. 290.
42.
Hadyn, W., P. Darko, and M. Colleen, <strong>FDG-PET-CT in Growing Teratoma Syndrome with Non-Seminomatous Testicular Mixed Germ Cell Tumor</strong>. Journal of Nuclear Medicine, 2017. 58(supplement 1): p. 1070.
43.
Kazama, T., et al., FDG PET in the evaluation of treatment for lymphoma: clinical usefulness and pitfalls. Radiographics, 2005. 25(1): p. 191-207.PubMedCrossRef
44.
Meignan, M., M. Hutchings, and L.H. Schwartz, Imaging in Lymphoma: The Key Role of Fluorodeoxyglucose-Positron Emission Tomography. Oncologist, 2015. 20(8): p. 890-5.PubMedPubMedCentralCrossRef
45.
Cristian, S., et al., Management of idiopathic retroperitoneal fibrosis from the urologist’s perspective. Ther Adv Urol, 2015. 7(2): p. 85-99.PubMedCrossRef
46.
Wang, Y., et al., The value of (18)F-FDG PET/CT in the distinction between retroperitoneal fibrosis and its malignant mimics. Semin Arthritis Rheum, 2018. 47(4): p. 593-600.PubMedCrossRef
47.
Devrim, E. and O. Antonio, Pattern recognition of renal FDG uptake in PET CT. Pictorial review. Journal of Nuclear Medicine, 2011. 52(supplement 1): p. 1031.
48.
Kochhar, R., et al., Role of FDG PET/CT in imaging of renal lesions. J Med Imaging Radiat Oncol, 2010. 54(4): p. 347-57.PubMedCrossRef
49.
Blake, M.A., et al., Renal oncocytoma displaying intense activity on 18F-FDG PET. AJR Am J Roentgenol, 2006. 186(1): p. 269-70.PubMedCrossRef
50.
51.
Zukotynski, K., et al., PET/CT and renal pathology: a blind spot for radiologists? Part 1, primary pathology. AJR Am J Roentgenol, 2012. 199(2): p. W163-7.PubMedCrossRef
52.
Dong, A., et al., (18)F-FDG PET/CT of adrenal lesions. AJR Am J Roentgenol, 2014. 203(2): p. 245-52.PubMedCrossRef
53.
Boland, G.W., et al., Characterization of adrenal masses by using FDG PET: a systematic review and meta-analysis of diagnostic test performance. Radiology, 2011. 259(1): p. 117-26.PubMedCrossRef
54.
Zhou, L., et al., Primary adrenal lymphoma: radiological; pathological, clinical correlation. Eur J Radiol, 2012. 81(3): p. 401-5.PubMedCrossRef
55.
Lam, K.Y. and C.Y. Lo, Metastatic tumours of the adrenal glands: a 30-year experience in a teaching hospital. Clin Endocrinol (Oxf), 2002. 56(1): p. 95-101.PubMedCrossRef
56.
Yun, M., et al., 18F-FDG PET in characterizing adrenal lesions detected on CT or MRI. J Nucl Med, 2001. 42(12): p. 1795-9.PubMed
57.
Leboulleux, S., et al., Diagnostic and prognostic value of 18-fluorodeoxyglucose positron emission tomography in adrenocortical carcinoma: a prospective comparison with computed tomography. J Clin Endocrinol Metab, 2006. 91(3): p. 920-5.PubMedCrossRef
58.
Jha, P., et al., Hybrid imaging for pancreatic malignancy: clinical applications, merits, limitations, and pitfalls. Clin Nucl Med, 2015. 40(3): p. 206-13.PubMedCrossRef
59.
van Kouwen, M.C., et al., FDG-PET is able to detect pancreatic carcinoma in chronic pancreatitis. Eur J Nucl Med Mol Imaging, 2005. 32(4): p. 399-404.PubMedCrossRef
60.
Heinrich, S., et al., Positron emission tomography/computed tomography influences on the management of resectable pancreatic cancer and its cost-effectiveness. Ann Surg, 2005. 242(2): p. 235-43.PubMedPubMedCentralCrossRef
61.
Evangelista, L., et al., The role of FDG PET/CT or PET/MRI in assessing response to neoadjuvant therapy for patients with borderline or resectable pancreatic cancer: a systematic literature review. Ann Nucl Med, 2021. 35(7): p. 767-776.PubMedPubMedCentralCrossRef
62.
Panda, A., et al., Borderline Resectable and Locally Advanced Pancreatic Cancer: FDG PET/MRI and CT Tumor Metrics for Assessment of Pathologic Response to Neoadjuvant Therapy and Prediction of Survival. AJR Am J Roentgenol, 2021. 217(3): p. 730-740.PubMedCrossRef
63.
Harder, F.N., et al., [18F]FDG PET/MRI enables early chemotherapy response prediction in pancreatic ductal adenocarcinoma. EJNMMI Research, 2021. 11(1): p. 70.PubMedPubMedCentralCrossRef
64.
Jha, P. and B. Bijan, PET/CT for Pancreatic Malignancy: Potential and Pitfalls. J Nucl Med Technol, 2015. 43(2): p. 92-7.PubMedCrossRef
65.
Abouzied, M.M., E.S. Crawford, and H.A. Nabi, 18F-FDG imaging: pitfalls and artifacts. J Nucl Med Technol, 2005. 33(3): p. 145-55; quiz 162-3.PubMed
66.
Yılmaz, S., et al., Metformin-Induced Intense Bowel Uptake Observed on Restaging FDG PET/CT Study in a Patient with Gastric Lymphoma. Mol Imaging Radionucl Ther, 2011. 20(3): p. 114-6.PubMedPubMedCentralCrossRef
67.
68.
69.
Reeps, C., et al., Increased 18F-fluorodeoxyglucose uptake in abdominal aortic aneurysms in positron emission/computed tomography is associated with inflammation, aortic wall instability, and acute symptoms. J Vasc Surg, 2008. 48(2): p. 417-23; discussion 424.PubMedCrossRef
70.
Kotze, C.W., et al., Increased metabolic activity in abdominal aortic aneurysm detected by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). Eur J Vasc Endovasc Surg, 2009. 38(1): p. 93-9.PubMedCrossRef
71.
Li, X. and W. Zhang, Clinical application of real-time PET/CT guided targeted retroperitoneal masses biopsy in diagnosing malignant tumors. BMC Cancer, 2023. 23(1): p. 829.PubMedPubMedCentralCrossRef
72.
Kumar, R., et al., Diagnostic performance of real-time robotic arm-assisted (18)F-FDG PET/CT-guided percutaneous biopsy in metabolically active abdominal and pelvic lesions. Eur J Nucl Med Mol Imaging, 2019. 46(4): p. 838-847.PubMedCrossRef
73.
Moreau, A., et al., Retroperitoneal fibrosis in on-going anti-PD-1 immunotherapy detected with [18F]-FDG PET/CT. European Journal of Nuclear Medicine and Molecular Imaging, 2019. 46(8): p. 1758-1759.PubMedCrossRef
74.
Daoussis, D., et al., Anti-PD-1 associated retroperitoneal fibrosis. Rheumatology (Oxford), 2021. 60(9): p. e329-e330.PubMedCrossRef
75.
Khessib, T., et al., Retroperitoneal Inflammation Detected on FDG PET/CT in Patient on Long-Term Immunotherapy. Clin Nucl Med, 2023. 48(4): p. e165-e166.PubMedCrossRef
76.
Ruhlmann, V., et al., (18)F-FDG PET/MRI evaluation of retroperitoneal fibrosis: a simultaneous multiparametric approach for diagnosing active disease. Eur J Nucl Med Mol Imaging, 2016. 43(9): p. 1646-52.PubMedCrossRef
77.
Galgano, S.J., et al., Applications of PET/MRI in Abdominopelvic Oncology. Radiographics, 2021. 41(6): p. 1750-1765.PubMedCrossRef
78.
79.
Corrigan, A.J., P.J. Schleyer, and G.J. Cook, Pitfalls and Artifacts in the Use of PET/CT in Oncology Imaging. Semin Nucl Med, 2015. 45(6): p. 481-99.PubMedCrossRef
80.
Finessi, M., G. Bisi, and D. Deandreis, Hyperglycemia and 18F-FDG PET/CT, issues and problem solving: a literature review. Acta Diabetologica, 2020. 57(3): p. 253-262.PubMedCrossRef
Metadata
Title
Overview of F18-FDG uptake patterns in retroperitoneal pathologies: imaging findings, pitfalls, and artifacts
Authors
Priya Pathak
Laith Abandeh
Hassan Aboughalia
Atefe Pooyan
Bahar Mansoori
Publication date
23-04-2024
Publisher
Springer US
Published in
Abdominal Radiology
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-023-04139-x
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