Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Insights into Imaging
Published in: Insights into Imaging 6/2011

Open Access 01-12-2011 | Pictorial Review

Causes and imaging features of false positives and false negatives on 18F-PET/CT in oncologic imaging

Authors: Niamh M. Long, Clare S. Smith

Published in: Insights into Imaging | Issue 6/2011

Login to get access

Abstract

Background

18F-FDG is a glucose analogue that is taken up by a wide range of malignancies. 18F-FDG PET-CT is now firmly established as an accurate method for the staging and restaging of various cancers. However, 18F-FDG also accumulates in normal tissue and other non-malignant conditions, and some malignancies do not take up F18-FDG or have a low affinity for the tracer, leading to false-positive and false-negative interpretations.

Methods

PET-CT allows for the correlation of two separate imaging modalities, combining both morphological and metabolic information. We should use the CT to help interpret the PET findings. In this article we will highlight specific false-negative and false-positive findings that one should be aware of when interpreting oncology scans.

Results

We aim to highlight post-treatment conditions that are encountered routinely on restaging scans that can lead to false-positive interpretations. We will emphasise the importance of using the CT component to help recognise these entities to allow improved diagnostic accuracy.

Conclusion

In light of the increased use of PET-CT, it is important that nuclear medicine physicians and radiologists be aware of these conditions and correlate the PET and CT components to avoid misdiagnosis, over staging of disease and unnecessary biopsies.
Literature
1.
Pauwels EK, Ribeiro MJ, Stoot JH et al (1998) FDG accumulation and tumor biology. Nucl Med Biol 25:317–322PubMedCrossRef
2.
Wahl RL (1996) Targeting glucose transporters for tumor imaging: “sweet” idea, “sour” result. J Nucl Med 37(6):1038–1041PubMed
3.
Kim BT, Kim Y, Lee KS, Yoon SB, Cheon EM, Kwon OJ, Rhee CH, Han J, Shin MH (1998) Localized form of bronchioalveolar carcinoma: FDG PET findings. AJR 170(4):935–939PubMedCrossRef
4.
Hoh CK, Hawkins RA, Glaspy JA, Dahlbom M, Tse NY, Hoffman EJ, Schiepers C, Choi Y, Rege S, Nitzsche E (1993) Cancer detection with whole-body PET using 2-[18F]fluoro-2-deoxy-D-glucose. J Comput Assist Tomogr 17(4):582–589PubMedCrossRef
5.
Fenchel S, Grab D, Nuessle K, Kotzerke J, Rieber A, Kreienberg R, Brambs HJ, Reske SN (2002) Asymptomatic adnexal masses: correlation of FDG PET and histopathologic findings. Radiology 223(3):780–788PubMedCrossRef
6.
Shreve PD, Anzai Y, Wahl RL (1999) Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants. Radiographics 19(1):61–77, quiz 150–151PubMedCrossRef
7.
Abouzied MM, Crawford ES, Nabi HA (2005) 18 F-FDG imaging: pitfalls and artifacts. J Nucl Med Technol 33(3):145–155PubMed
8.
Boellaard R, O'Doherty MJ, Weber WA, Mottaghy FM, Lonsdale MN, Stroobants SG, Oyen WJ, Kotzerke J, Hoekstra OS, Pruim J, Marsden PK, Tatsch K, Hoekstra CJ, Visser EP, Arends B, Verzijlbergen FJ, Zijlstra JM, Comans EF, Lammertsma AA, Paans AM, Willemsen AT, Beyer T, Bockisch A, Schaefer-Prokop C, Delbeke D, Baum RP, Chiti A, Krause BJ (2010) FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging 37(1):181–200PubMedPubMedCentralCrossRef
9.
Sureshbabu W, Mawlawi O (2005) PET/CT imaging artifacts. J Nucl Med Technol 33(3):156–161, quiz 163–164PubMed
10.
Lin E, Alavi A (2009) PET and PET/CT: A Clinical Guide: 2nd Edn. Thieme New York p 145
11.
Hany TF, Heuberger J, von Schulthess GK (2003) Iatrogenic FDG foci in the lungs: a pitfall of PET image interpretation. Eur Radiol 13(9):2122–2127, Epub 2002 Oct 17PubMedCrossRef
12.
Kazama T, Faria SC, Varavithya V, Phongkitkarun S, Ito H, Macapinlac HA (2005) FDG PET in the evaluation of treatment for lymphoma: clinical usefulness and pitfalls. Radiographics 25(1):191–207PubMedCrossRef
13.
Swanson DP, Chilton HM, Thrall JH (1990) Pharmaceuticals in medical imaging. Macmillan, New York
14.
Prabhakar HB, Sahani DV, Fischman AJ, Mueller PR, Blake MA (2007) Bowel hot spots at PET-CT. Radiographics 27(1):145–159PubMedCrossRef
15.
Yeung HW, Grewal RK, Gonen M, Schöder H, Larson SM (2003) Patterns of (18)F-FDG uptake in adipose tissue and muscle: a potential source of false-positives for PET. J Nucl Med 44(11):1789–1796PubMed
16.
Truong MT, Erasmus JJ, Munden RF, Marom EM, Sabloff BS, Gladish GW, Podoloff DA, Macapinlac HA (2004) Focal FDG uptake in mediastinal brown fat mimicking malignancy: a potential pitfall resolved on PET/CT. Am J Roentgenol 183(4):1127–1132CrossRef
17.
Söderlund V, Larsson SA, Jacobsson H (2007) Reduction of FDG uptake in brown adipose tissue in clinical patients by a single dose of propranolol. Eur J Nucl Med Mol Imaging 34(7):1018–1022PubMedCrossRef
18.
Sumi M, Ohki M, Nakamura T (2001) Comparison of sonography and CT for differentiating benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck. AJR 176(4):1019–1024PubMedCrossRef
19.
Lerman H, Metser U, Grisaru D, Fishman A, Lievshitz G, Even-Sapir E (2004) Normal and abnormal 18 F-FDG endometrial and ovarian uptake in pre- and postmenopausal patients: assessment by PET/CT. J Nucl Med 45(2):266–271PubMed
20.
Lu Y, Xie D, Huang W, Gong H, Yu J (2010) 18 F-FDG PET/CT in the evaluation of adrenal masses in lung cancer patients. Neoplasma 57(2):129–134PubMedCrossRef
21.
Boland GW, Blake MA, Holalkere NS, Hahn PF (2009) PET/CT for the characterization of adrenal masses in patients with cancer: qualitative versus quantitative accuracy in 150 consecutive patients. AJR Am J Roentgenol 192(4):956–962PubMedCrossRef
22.
Chen W, Parsons M, Torigian DA, Zhuang H, Alavi A (2009) Evaluation of thyroid FDG uptake incidentally identified on FDG-PET/CT imaging. Nucl Med Commun 30(3):240–244PubMedCrossRef
23.
Choi JY, Lee KS, Kim HJ, Shim YM, Kwon OJ, Park K, Baek CH, Chung JH, Lee KH, Kim BT (2006) Focal thyroid lesions incidentally identified by integrated 18 F-FDG PET/CT: clinical significance and improved characterization. J Nucl Med 47(4):609–615PubMed
24.
Blake MA, Slattery J, Sahani DV, Kalra MK (2005) Practical issues in abdominal PET/CT. Appl Radiol 34(11):8–18
25.
Kei PL, Vikram R, Yeung HW, Stroehlein JR, Macapinlac HA (2010) Incidental finding of focal FDG uptake in the bowel during PET/CT: CT features and correlation with histopathologic results. AJR Am J Roentgenol 194(5):W401–W406PubMedCrossRef
26.
Pandit-Taskar N, Schöder H, Gonen M, Larson SM, Yeung HW (2004) Clinical significance of unexplained abnormal focal FDG uptake in the abdomen during whole-body PET. AJR Am J Roentgenol 183(4):1143–1147PubMedCrossRef
27.
Kamel EM, Thumshirn M, Truninger K, Schiesser M, Fried M, Padberg B, Schneiter D, Stoeckli SJ, von Schulthess GK, Stumpe KD (2004) Significance of incidental 18 F-FDG accumulations in the gastrointestinal tract in PET/CT: correlation with endoscopic and histopathologic results. J Nucl Med 45(11):1804–1810PubMed
28.
Smith CS, Schöder H, Yeung HW (2007) Thymic extension in the superior mediastinum in patients with thymic hyperplasia: potential cause of false-positive findings on 18 F-FDG PET/CT. AJR Am J Roentgenol 188(6):1716–1721PubMedCrossRef
29.
Ferdinand B, Gupta P, Kramer EL (2004) Spectrum of thymic uptake at 18 F-FDG PET. Radiographics 24(6):1611–1616PubMedCrossRef
30.
Baron RL, Lee JK, Sagel SS, Levitt RG (1982) Computed tomography of the abnormal thymus. Radiology 142(1):127–134PubMedCrossRef
31.
Hollinger EF, Alibazoglu H, Ali A, Green A, Lamonica G (1998) Hematopoietic cytokine-mediated FDG uptake simulates the appearance of diffuse metastatic disease on whole-body PET imaging. Clin Nucl Med 23(2):93–98PubMedCrossRef
32.
Kazama T, Swanston N, Podoloff DA, Macapinlac HA (2005) Effect of colony-stimulating factor and conventional- or high-dose chemotherapy on FDG uptake in bone marrow. Eur J Nucl Med Mol Imaging 32(12):1406–1411PubMedCrossRef
33.
Claude L, Pérol D, Ginestet C, Falchero L, Arpin D, Vincent M, Martel I, Hominal S, Cordier JF, Carrie C (2004) A prospective study on radiation pneumonitis following conformal radiation therapy in non-small-cell lung cancer: clinical and dosimetric factors analysis. Radiother Oncol 71(2):175–181PubMedCrossRef
34.
Frank A, Lefkowitz D, Jaeger S, Gobar L, Sunderland J, Gupta N, Scott W, Mailliard J, Lynch H, Bishop J et al (1995) Decision logic for retreatment of asymptomatic lung cancer recurrence based on positron emission tomography findings. Int J Radiat Oncol Biol Phys 32(5):1495–1512PubMedCrossRef
35.
Love C, Tomas MB, Tronco GG, Palestro CJ (2005) FDG PET of infection and inflammation. Radiographics 25(5):1357–1368PubMedCrossRef
36.
Chang JM, Lee HJ, Goo JM, Lee HY, Lee JJ, Chung JK, Im JG (2006) False positive and false negative FDG-PET scans in various thoracic diseases. Korean J Radiol 7(1):57–69PubMedPubMedCentralCrossRef
37.
Kwek BH, Aquino SL, Fischman AJ (2004) Fluorodeoxyglucose positron emission tomography and CT after talc pleurodesis. Chest 125(6):2356–2360PubMedCrossRef
38.
Coleman RE, Mashiter G, Whitaker KB, Moss DW, Rubens RD, Fogelman I (1988) Bone scan flare predicts successful systemic therapy for bone metastases. J Nucl Med 29(8):1354–1359PubMed
39.
Krupitskaya Y, Eslamy HK, Nguyen DD, Kumar A, Wakelee HA (2009) Osteoblastic Bone Flare on F18-FDG PET in Non-small Cell Lung Cancer (NSCLC) Patients Receiving Bevacizumab in addition to standard Chemotherapy. J Thorac Oncol 4(3):429–431PubMedCrossRef
40.
Talamo G, Angtuaco E, Walker RC, Dong L, Miceli MH, Zangari M, Tricot G, Barlogie B, Anaissie E (2005) Avascular necrosis of femoral and/or humeral heads in multiple myeloma: results of a prospective study of patients treated with dexamethasone-based regimens and high-dose chemotherapy. J Clin Oncol 23(22):5217–5223PubMedCrossRef
41.
Catalano L, Del Vecchio S, Petruzziello F, Fonti R, Salvatore B, Martorelli C, Califano C, Caparrotti G, Segreto S, Pace L, Rotoli B (2007) Sestamibi and FDG-PET scans to support diagnosis of jaw osteonecrosis. Ann Hematol 86(6):415–423PubMedCrossRef
42.
Arce K, Assael LA, Weissman JL, Markiewicz MR (2009) MR imaging findings in bisphosphonate-related osteonecrosis of jaws. J Oral Maxillofac Surg 67(5 Suppl):75–84PubMedCrossRef
43.
Oh D, Huh SJ, Lee SJ, Kwon JW (2009) Variation in FDG uptake on PET in patients with radiation-induced pelvic insufficiency fractures: a review of 10 cases. Ann Nucl Med 23(6):511–516PubMedCrossRef
44.
Erasmus JJ, McAdams HP, Patz EF Jr, Coleman RE, Ahuja V, Goodman PC (1998) Evaluation of primary pulmonary carcinoid tumors using FDG PET. AJR Am J Roentgenol 170(5):1369–1373PubMedCrossRef
45.
Kang DE, White RL Jr, Zuger JH, Sasser HC, Teigland CM (2004) Clinical use of fluorodeoxyglucose F 18 positron emission tomography for detection of renal cell carcinoma. J Urol 171(5):1806–1809PubMedCrossRef
46.
Khan MA, Combs CS, Brunt EM, Lowe VJ, Wolverson MK, Solomon H, Collins BT, Di Bisceglie AM (2000) Positron emission tomography scanning in the evaluation of hepatocellular carcinoma. J Hepatol 32(5):792–797PubMedCrossRef
47.
Berger KL, Nicholson SA, Dehdashti F, Siegel BA (2000) FDG PET evaluation of mucinous neoplasms: correlation of FDG uptake with histopathologic features. AJR Am J Roentgenol 174(4):1005–1008PubMedCrossRef
48.
Jerusalem G, Beguin Y, Najjar F, Hustinx R, Fassotte MF, Rigo P, Fillet G (2001) Positron emission tomography (PET) with 18 F-fluorodeoxyglucose (18 F-FDG) for the staging of low-grade non-Hodgkin's lymphoma (NHL). Ann Oncol 12(6):825–830PubMedCrossRef
49.
Tateishi U, Gamez C, Dawood S, Yeung HW, Cristofanilli M, Macapinlac HA (2008) Bone metastases in patients with metastatic breast cancer: morphologic and metabolic monitoring of response to systemic therapy with integrated PET/CT. Radiology 247(1):189–196PubMedCrossRef
50.
Huyge V, Garcia C, Vanderstappen A, Alexiou J, Gil T, Flamen P (2009) Progressive osteoblastic bone metastases in breast cancer negative on FDG-PET. Clin Nucl Med 34(7):417–420PubMedCrossRef
Metadata
Title
Causes and imaging features of false positives and false negatives on 18F-PET/CT in oncologic imaging
Authors
Niamh M. Long
Clare S. Smith
Publication date
01-12-2011
Publisher
Springer Berlin Heidelberg
Published in
Insights into Imaging / Issue 6/2011
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1007/s13244-010-0062-3

Other articles of this Issue 6/2011

Insights into Imaging 6/2011 Go to the issue

Pictorial Review

Imaging of breast implants—a pictorial review

Statement

Medical imaging in personalised medicine: a white paper of the research committee of the European Society of Radiology (ESR)

Review

Contrast-enhanced ultrasound (CEUS) in Crohn’s disease: technique, image interpretation and clinical applications

Original Article

The radiation burden from increasingly complex endovascular aortic aneurysm repair

Original Article

Pineal cysts in children

Pictorial Review

A primer to common major gastrointestinal post-surgical anatomy on CT—a pictorial review