False-positive FDG PET Uptake--the Role of PET/CT

Overview

Journal Eur Radiol

Specialty Radiology

Date 2005 Dec 21

PMID 16365730

Citations 105

Authors

Sandra J Rosenbaum

Thomas Lind

Gerald Antoch

Andreas Bockisch

Affiliations

Soon will be listed here.

Abstract

Positron emission tomography (PET) is a powerful molecular imaging technique for the human body-imaging applications currently available. As altered glucose metabolism is characteristic for many malignancies, FDG-PET is mostly used in oncology for staging and therapy control. Although PET is a sensitive tool for detecting malignancy, FDG uptake is not tumor specific. It can also be seen in healthy tissue or in benign disease as inflammation or posttraumatic repair and could be mistaken for cancer. The experienced nuclear medicine physician mostly manages to differentiate malignant from non-malignant FDG uptake, but some findings may remain ambiguous. In these cases, the difficulties in differentiating physiologic variants or benign causes of FDG uptake from tumor tissue can often be overcome by combined PET and CT (PET/CT) as anatomic information is added to the metabolic data. Thus, PET/CT improves the diagnostic accuracy compared to PET alone and helps to avoid unnecessary surgery/therapy. However, PET/CT involves other sources of artifacts that may occur when using CT for attenuation correction of PET or by patient motion caused by respiration or bowel movements.

Citing Articles

Pilomatrixoma of the parotid region: A benign tumor mimicking metastatic cutaneous squamous cell carcinoma.

Grieder N, Pucci M, De Vito C, Monnier Y, Dulguerov N, Mermod M Radiol Case Rep. 2025; 20(4):2159-2162.

PMID: 39975649 PMC: 11835548. DOI: 10.1016/j.radcr.2025.01.065.

A Rare Case of Adrenal Gland Metastasis from Parotid Adenocarcinoma: Unveiling the Potential Augmented Utility of FAPI PET/CT.

Al-Ibraheem A, Abdulrahman M, Alrousan M, Haidar M Indian J Nucl Med. 2025; 39(4):309-312.

PMID: 39790817 PMC: 11708800. DOI: 10.4103/ijnm.ijnm_13_24.

The Diagnostic Value of Endobronchial Ultrasound-Guided Fine Needle Aspiration (EBUS-FNA) in Diagnosing FDG-PET-Avid Lymph Nodes in Extrapulmonary Malignancies.

Sana M, Mahmood Butt F, Amir A Cureus. 2024; 16(8):e68269.

PMID: 39350840 PMC: 11440340. DOI: 10.7759/cureus.68269.

Plasma Metabolite Profiling in the Search for Early-Stage Biomarkers for Lung Cancer: Some Important Breakthroughs.

Meynen J, Adriaensens P, Criel M, Louis E, Vanhove K, Thomeer M Int J Mol Sci. 2024; 25(9).

PMID: 38731909 PMC: 11083579. DOI: 10.3390/ijms25094690.

Head-to-head comparison of [Ga]Ga-DOTA-FAPI-04 and [F]FDG PET/CT for the evaluation of tonsil cancer and lymph node metastases: a single-centre retrospective study.

Ji M, Ma G, Liu C, Gu B, Du X, Ou X Cancer Imaging. 2024; 24(1):56.

PMID: 38702821 PMC: 11069139. DOI: 10.1186/s40644-024-00699-3.

References

Dehdashti F, Siegel B, Griffeth L, Fusselman M, Trask D, McGuire A . Benign versus malignant intraosseous lesions: discrimination by means of PET with 2-[F-18]fluoro-2-deoxy-D-glucose. Radiology. 1996; 200(1):243-7. DOI: 10.1148/radiology.200.1.8657920. View

Kosuda S, Fisher S, Kison P, Wahl R, Grossman H . Uptake of 2-deoxy-2-[18F]fluoro-D-glucose in the normal testis: retrospective PET study and animal experiment. Ann Nucl Med. 1997; 11(3):195-9. DOI: 10.1007/BF03164763. View

von Schulthess G, Meier N, Stumpe K . Joint accumulations of FDG in whole body PET scans. Nuklearmedizin. 2002; 40(6):193-7. View

Yasuda S, Shohtsu A, Ide M, Takagi S, Takahashi W, Suzuki Y . Chronic thyroiditis: diffuse uptake of FDG at PET. Radiology. 1998; 207(3):775-8. DOI: 10.1148/radiology.207.3.9609903. View

Lin E, Helgans R . Adrenal hyperplasia in Cushing's syndrome demonstrated by FDG positron emission tomographic imaging. Clin Nucl Med. 2002; 27(7):516-7. DOI: 10.1097/00003072-200207000-00010. View

Chung J, Cho K, Lee S, Baek H, Park J, Cheon G . Overexpression of Glut1 in lymphoid follicles correlates with false-positive (18)F-FDG PET results in lung cancer staging. J Nucl Med. 2004; 45(6):999-1003. View

Avril N . GLUT1 expression in tissue and (18)F-FDG uptake. J Nucl Med. 2004; 45(6):930-2. View

Antoch G, Freudenberg L, Egelhof T, Stattaus J, Jentzen W, Debatin J . Focal tracer uptake: a potential artifact in contrast-enhanced dual-modality PET/CT scans. J Nucl Med. 2002; 43(10):1339-42. View

Sugawara Y, Fisher S, Zasadny K, Kison P, Baker L, Wahl R . Preclinical and clinical studies of bone marrow uptake of fluorine-1-fluorodeoxyglucose with or without granulocyte colony-stimulating factor during chemotherapy. J Clin Oncol. 1998; 16(1):173-80. DOI: 10.1200/JCO.1998.16.1.173. View

10.

Fujii H, Ide M, Yasuda S, Takahashi W, Shohtsu A, Kubo A . Increased FDG uptake in the wall of the right atrium in people who participated in a cancer screening program with whole-body PET. Ann Nucl Med. 1999; 13(1):55-9. DOI: 10.1007/BF03165430. View

11.

Osman M, Cohade C, Nakamoto Y, Wahl R . Respiratory motion artifacts on PET emission images obtained using CT attenuation correction on PET-CT. Eur J Nucl Med Mol Imaging. 2003; 30(4):603-6. DOI: 10.1007/s00259-002-1024-x. View

12.

Beyer T, Antoch G, Bockisch A, Stattaus J . Optimized intravenous contrast administration for diagnostic whole-body 18F-FDG PET/CT. J Nucl Med. 2005; 46(3):429-35. View

13.

Lerman H, Metser U, Grisaru D, Fishman A, Lievshitz G, Even-Sapir E . Normal and abnormal 18F-FDG endometrial and ovarian uptake in pre- and postmenopausal patients: assessment by PET/CT. J Nucl Med. 2004; 45(2):266-71. View

14.

Yeung H, Grewal R, Gonen M, Schoder H, Larson S . Patterns of (18)F-FDG uptake in adipose tissue and muscle: a potential source of false-positives for PET. J Nucl Med. 2003; 44(11):1789-96. View

15.

Yun M, Kim W, Alnafisi N, Lacorte L, Jang S, Alavi A . 18F-FDG PET in characterizing adrenal lesions detected on CT or MRI. J Nucl Med. 2001; 42(12):1795-9. View

16.

Hany T, Gharehpapagh E, Kamel E, Buck A, Himms-Hagen J, von Schulthess G . Brown adipose tissue: a factor to consider in symmetrical tracer uptake in the neck and upper chest region. Eur J Nucl Med Mol Imaging. 2002; 29(10):1393-8. DOI: 10.1007/s00259-002-0902-6. View

17.

Denecke T, Rau B, Hoffmann K, Hildebrandt B, Ruf J, Gutberlet M . Comparison of CT, MRI and FDG-PET in response prediction of patients with locally advanced rectal cancer after multimodal preoperative therapy: is there a benefit in using functional imaging?. Eur Radiol. 2005; 15(8):1658-66. DOI: 10.1007/s00330-005-2658-4. View

18.

Kamel E, Burger C, Buck A, von Schulthess G, Goerres G . Impact of metallic dental implants on CT-based attenuation correction in a combined PET/CT scanner. Eur Radiol. 2003; 13(4):724-8. DOI: 10.1007/s00330-002-1564-2. View

19.

Wahl R . Why nearly all PET of abdominal and pelvic cancers will be performed as PET/CT. J Nucl Med. 2004; 45 Suppl 1:82S-95S. View

20.

Bockisch A, Beyer T, Antoch G, Freudenberg L, Kuhl H, Debatin J . Positron emission tomography/computed tomography--imaging protocols, artifacts, and pitfalls. Mol Imaging Biol. 2004; 6(4):188-99. DOI: 10.1016/j.mibio.2004.04.006. View