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¹⁸F-FDG Imaging: Pitfalls and Artifacts^*

Nuclear Medicine Department, University at Buffalo, Buffalo, New York

View larger version (36K): [in a new window]   FIGURE 1. Asymmetric salivary gland uptake (projection view). Note increased 18F-FDG uptake in right face/salivary gland and region (arrow) as compared with contralateral side. Patient’s head moved during acquisition. SUV = standardized uptake value.

View larger version (47K): [in a new window]   FIGURE 2. Symmetric salivary gland uptake (projection view; arrows) shows mild uptake.

View larger version (25K): [in a new window]   FIGURE 3. Laryngeal uptake. (A) Normal symmetric uptake in larynx. (B) Focal unilateral (arrows). Coronal view on left; transaxial view on right.

View larger version (53K): [in a new window]   FIGURE 4. Thyroid inflammation. (A) Patient with known squamous cell carcinoma of upper lobe of right lung (thick arrow) who was being evaluated for initial staging. Note intense thyroid uptake due to Hashimoto’s thyroiditis. Also note normal stomach uptake (thin arrow). (B) A 57-y-old woman with history of breast carcinoma and left thyroidectomy who was being evaluated because of rising levels of tumor markers. Neck uptake was due to Hashimoto’s thyroiditis, which could easily have been mistaken for nodal uptake. C = coronal.

View larger version (98K): [in a new window]   FIGURE 5. Focal thyroid uptake. (A) Focal thyroid uptake seen in right lobe of thyroid gland corresponding to focal density (arrow) seen on CT scan (B). ANT = anterior; POS = posterior; C = coronal.

View larger version (40K): [in a new window]   FIGURE 6. (A) Cardiac uptake: Normal physiologic intense 18F-FDG uptake throughout myocardium. (B) Atrial uptake: Note inhomogeneous mild 18F-FDG uptake in enlarged right atrium resembling abnormal mediastinal nodal tissue uptake. Thick arrow points out normal stomach uptake. (C) Cardiac uptake: Apical scar with aneurismal formation.

View larger version (58K): [in a new window]   FIGURE 7. Stomach uptake. (A) Normal uptake: mild diffuse uptake (arrows) conforming to stomach configuration. (B) Adenocarcinoma of stomach: focal uptake in region of stomach. Coronal view on left; sagittal view on right. (C) Stomach lymphoma: intense focal uptake (arrows). S = sagittal; C = coronal; ANT = anterior; POS = posterior.

View larger version (59K): [in a new window]   FIGURE 8. Dilated esophagus. A 72-y-old man with known esophageal carcinoma. Note dilated esophagus with linear increased uptake on both sides. Chronic dilation is due to distal obstruction by tumor mass. Linear uptake is due to reactive inflammation. ANT = anterior; POS = posterior; S = sagittal; C = coronal.

View larger version (61K): [in a new window]   FIGURE 9. Esophageal uptake. Esophageal uptake in patient with gastroesophageal reflux disease. S = sagittal; C = coronal; ANT = anterior; POS = posterior.

View larger version (46K): [in a new window]   FIGURE 10. Colonic activity (projection view). Patient had bladder cancer, status post cystostomy, and ileal conduit. PET was done to rule out pelvic recurrence. Note nonspecific diffuse colonic activity (a), ileal conduit (b), urinary bag (c), and area of recurrence (d).

View larger version (74K): [in a new window]   FIGURE 11. Cecal uptake. (A and B) Normal diffuse physiologic uptake (arrow) in cecum. C = coronal.

View larger version (39K): [in a new window]   FIGURE 12. Dilated urinary bladder. Note prominent right (Rt) kidney collecting system, right ureter, and dilated urinary bladder.

View larger version (79K): [in a new window]   FIGURE 13. Horseshoe kidney. (A) Horseshoe kidney (arrow) seen on 18F-FDG PET scan (projection view on left). Patient with Hodgkin’s lymphoma. (B) 99mTc-Glucoheptonate scan confirms presence of horseshoe kidney.

View larger version (101K): [in a new window]   FIGURE 14. Renal activity. (A) Intense activity in right kidney collecting system overlapping right lobe of liver, simulating a liver lesion. (B) 99mTc-Dimercaptosuccinic acid image of same patient confirms that right kidney is slightly higher than left. Post = posterior.

View larger version (32K): [in a new window]   FIGURE 15. Bladder diverticulum. (A) Bladder diverticulum caused by chronic bladder outlet obstruction by hypertrophied prostate. (B) Corresponding CT scan. ANT = anterior; POST = posterior; S = sagittal; C = coronal.

View larger version (65K): [in a new window]   FIGURE 16. (A) Nephrostomy tube (arrow). (B) Diaper artifact. POS = posterior.

View larger version (65K): [in a new window]   FIGURE 17. Muscle uptake. Symmetric muscle uptake in neck (arrows). C= coronal.

View larger version (119K): [in a new window]   FIGURE 18. Intercostal muscle uptake due to persistent coughing (projection view).

View larger version (50K): [in a new window]   FIGURE 19. Brown fat uptake. (A) Asymmetric neck uptake (arrows). (B) Intense symmetric uptake in adipose tissue (arrows). Brown fat can cause difficulty in scan interpretation. C = coronal.

View larger version (30K): [in a new window]   FIGURE 20. Thymus uptake (coronal views). (A) Diffuse thymus uptake (arrow). (B) Focal thymus uptake (arrow).

View larger version (76K): [in a new window]   FIGURE 21. Bone marrow. Intense 18F-FDG uptake in bone marrow is attributed to hematopoietic growth factor.

View larger version (69K): [in a new window]   FIGURE 22. Spleen uptake (arrows) due to hematopoietic growth factor.

View larger version (91K): [in a new window]   FIGURE 23. 18F-FDG uptake in lymph nodes attributed to tuberculosis (projection view).

View larger version (53K): [in a new window]   FIGURE 24. Fungal infection in liver of pediatric patient. (A) Before therapy (arrow). (B) Infection resolved on image after specific antifungal therapy.

View larger version (79K): [in a new window]   FIGURE 25. Scar tissue from recent surgery. Patient underwent recent abdominal surgery for hernia repair. Note linear superficial increased 18F-FDG uptake along anterior abdominal wall conforming to abdominal scar tissue (arrow). S = sagittal; C = coronal; ANT = anterior; POS = posterior.

View larger version (23K): [in a new window]   FIGURE 26. Abdominal fibrosis, honeycomb appearance. Patient had history of multiple abdominal surgeries leading to scattered segmental fibrosis. Image shows mild 18F-FDG uptake between dilated loops of bowel forming the honeycomb appearance. C = coronal.

View larger version (21K): [in a new window]   FIGURE 27. Uptake in sternum after coronary artery bypass grafting. Patient had open-heart surgery 1 wk before 18F-FDG study. S = sagittal; C = coronal.

View larger version (25K): [in a new window]   FIGURE 28. Postsurgical hematoma (arrows). Patient had excisional breast biopsy 10 d before 18F-FDG scan. ANT = anterior; POS = posterior; S = sagittal; C = coronal.

View larger version (48K): [in a new window]   FIGURE 29. Intense aortic uptake due to inflammation (unstable plaque formation).

View larger version (36K): [in a new window]   FIGURE 30. Breast uptake, lactating female. ANT = anterior; POS = posterior; C = coronal.