Benign Nonphysiologic Lesions with Increased <sup>18</sup>F-FDG Uptake on PET/CT: Characterization and Incidence

Metser, Ur; Miller, Elka; Lerman, Hedva; Even-Sapir, Einat

doi:10.2214/ajr.07.2083

Cited by 134 publications

(103 citation statements)

References 16 publications

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“…5). This concern can presumably be explained by the known variations in increased 18 F-FDG uptake by many benign, physiologic processes and conditions (4,(12)(13)(14). This observation is also significant because it expresses the concerns of the referring physicians for frequent up-staging of oncologic patients with 18 F-FDG PET/CT, with the consequent changes in patient management.…”

Section: Discussionmentioning

confidence: 99%

Oncologic ¹⁸F-FDG PET/CT: Referring Physicians’ Point of View

et al. 2012

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Oncologic 18 F-FDG PET/CT is rapidly gaining acceptance in clinical practice. However, the referring physician's attitude toward the usefulness of this diagnostic modality is unknown. This survey was undertaken to collect information regarding the current perspective of referring physicians on oncologic PET/CT. Methods: We conducted a prospective worldwide, Web-based survey of physicians who manage cancer patients. A total of 963 referring physicians completed a 20-question survey focused on their experience with oncologic 18 F-FDG PET/CT. Attention was directed toward their confidence about indications, their satisfaction with related educational resources, the quality of interaction with interpreting physicians, and practical problems encountered. The respondents included oncologists (38.5%, n 5 371), hematologists (16.4%, n 5 158), radiation oncologists (9.0%, n 5 87), surgeons (30.3%, n 5 292), and other physicians (5.7%, n 5 55). Results: Only 25.2% of respondents considered the oncologic 18 F-FDG PET/ CT indications to be well established and defined. Frequent uncertainty about the need for a PET scan was indicated by 62.3% of the respondents. High cost and overinterpretation of findings were the most commonly reported concerns (47.0% and 40.9%, respectively). The experience and skill level of the interpreting physician was considered very important by 96.8% of the surveyed physicians. Conclusion: Referring physicians expressed considerable uncertainty about the appropriate use of oncologic PET/CT. Additional major concerns are procedure costs and quality of interpretation. The responses suggest a strong need for efforts to educate referring and interpreting physicians about the appropriate use of 18 F-FDG PET/CT in oncology.

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Section: Discussionmentioning

confidence: 99%

Oncologic ¹⁸F-FDG PET/CT: Referring Physicians’ Point of View

et al. 2012

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“…The maximum standard uptake values (SUV max ) of these lesions were substantially > 3.0 and comparable to the uptake of FDGavid malignant lesions. These findings demand careful image interpretation implicating false-positive results [2,3]. Our case illustrates the usefulness of 18 F-FDG PET/CT in mapping active tuberculous lesions which can be used for baseline study [4].…”

mentioning

confidence: 88%

Disseminated tuberculosis infection: a ‘super’ 18F-FDG PET/CT appearance

Nordin

Rossetti

Rahim

2009

Eur J Nucl Med Mol Imaging

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A 28-year-old immigrant presented with a 2-week history of throbbing headache. Contrast-enhanced computed tomography (CECT) examination showed multiple brain abscesses. He is a known defaulter from miliary tuberculosis treatment. 18 F-FDG PET/CT demonstrated multiple visually high metabolic activity lesions disseminated in the brain, thorax, abdomen and pelvis [1]. The maximum standard uptake values (SUV max ) of these lesions were substantially > 3.0 and comparable to the uptake of FDGavid malignant lesions. These findings demand careful image interpretation implicating false-positive results [2,3]. Our case illustrates the usefulness of 18 F-FDG PET/CT in mapping active tuberculous lesions which can be used for baseline study [4].

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“…5,[14][15][16] Despite its advantages, PET/CT is most limited by its falsepositive rate, because nonspecific FDG-labeled glucose uptake is known to occur in the setting of inflammation or infection. 15,17,18 For example, a retrospective review of more than 1000 cancer patients determined that 25% of PET/CT positive lesions were benign, and more than 75% of this was because of inflammation. 17 Because these ''false-positives'' have clinical implications for our patients, a brief review of FDG uptake mechanisms is appropriate to better understand why false-positives occur and how radiologists may limit them.…”

Section: What Is Pet Scanning?mentioning

confidence: 99%

Fluorodeoxyglucose-Positron-Emission Tomography/Computed Tomography Imaging for Adrenal Masses in Patients with Lung Cancer: Review and Diagnostic Algorithm

Stone

Wymer

Canales

2014

Journal of Endourology

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Background and Purpose: Positron-emission tomography/computed tomography (PET/CT) with fluorine-18 fluorodeoxyglucose (FDG) is used as first-line staging for patients with newly diagnosed non-small cell lung cancer (NSCLC). Our purpose was to review the accuracy of FDG-PET/CT to predict adrenal gland metastasis, explain the causes for false-positive PET, and provide a diagnostic algorithm. Patients and Methods: Two patients with incidentally discovered lung masses were found to have hypermetabolic adrenal activity by FDG-PET/CT with maximal standard uptake value (SUV) of 4.5 and 6.5. A MEDLINE search was performed on the topic of FDG-PET/CT, adrenal gland metastasis, and NSCLC. Literature was reviewed with regard to diagnosis, accuracy, outcomes, and alternative imaging or diagnostic strategies. Results: Both patients underwent transabdominal laparoscopic adrenalectomy and were found to have nodular hyperplasia without evidence of adrenal tumor. A total of seven articles containing 343 patients were identified as having pertinent oncologic information for NSCLC patients with adrenal lesions. Sensitivity and specificity of PET/CT for distant metastasis was 94% and 85%, respectively, but only 13% (44/343) of these patients had histologically confirmed adrenal diagnoses. Based on this, a diagnostic algorithm was created to aid in decision making. Conclusions: Although PET/CT has high sensitivity and specificity for adrenal metastasis in the setting of NSCLC, adrenal biopsy or other secondary imaging should be considered to confirm the finding. Adrenalectomy in lieu of biopsy may have both diagnostic and therapeutic benefit in cases where the adrenal mass is ‡ 10 mm with high PET maximum SUV ( ‡ 3.1) and SUV ratios ( > 2.5), where washout CT or chemical shift MRI is positive, or where percutaneous biopsy is deemed too difficult or unsafe.

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Benign Nonphysiologic Lesions with Increased ¹⁸F-FDG Uptake on PET/CT: Characterization and Incidence

Cited by 134 publications

References 16 publications

Oncologic ¹⁸F-FDG PET/CT: Referring Physicians’ Point of View

Oncologic ¹⁸F-FDG PET/CT: Referring Physicians’ Point of View

Disseminated tuberculosis infection: a ‘super’ 18F-FDG PET/CT appearance

Fluorodeoxyglucose-Positron-Emission Tomography/Computed Tomography Imaging for Adrenal Masses in Patients with Lung Cancer: Review and Diagnostic Algorithm

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Benign Nonphysiologic Lesions with Increased 18F-FDG Uptake on PET/CT: Characterization and Incidence

Cited by 134 publications

References 16 publications

Oncologic 18F-FDG PET/CT: Referring Physicians’ Point of View

Oncologic 18F-FDG PET/CT: Referring Physicians’ Point of View

Disseminated tuberculosis infection: a ‘super’ 18F-FDG PET/CT appearance

Fluorodeoxyglucose-Positron-Emission Tomography/Computed Tomography Imaging for Adrenal Masses in Patients with Lung Cancer: Review and Diagnostic Algorithm

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Benign Nonphysiologic Lesions with Increased ¹⁸F-FDG Uptake on PET/CT: Characterization and Incidence

Oncologic ¹⁸F-FDG PET/CT: Referring Physicians’ Point of View

Oncologic ¹⁸F-FDG PET/CT: Referring Physicians’ Point of View