Imaging of Pelvic Malignancies with In-Line FDG PET–CT: Case Examples and Common Pitfalls of FDG PET

Published Online:https://doi.org/10.1148/rg.254045155

The role of 2-[fluorine 18]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) in combination with computed tomography (CT) in the evaluation of pelvic malignancies has been rapidly growing in recent years. FDG PET has proved to be valuable in the evaluation of a variety of pelvic malignancies, including colorectal cancer, uterine cervical cancer, ovarian cancer, endometrial cancer, and non-Hodgkin lymphoma. However, a number of pitfalls are commonly encountered at FDG PET, including normal physiologic activity in bowel, ovaries, endometrium, and blood vessels and focal retained activity in ureters, bladder diverticula, pelvic kidneys, and urinary diversions. The use of an in-line FDG PET–CT system, with special attention given to proper patient preparation and scanning protocol, often provides valuable information to help localize and define disease and avoid potential diagnostic pitfalls.

© RSNA, 2005

References

  • 1 CohadeC, Osman M, Nakamoto Y, et al. Initial experience with oral contrast in PET/CT: phantom and clinical studies. J Nucl Med2003; 44: 412–416.
  • 2 GoerresGW, Ziegler SI, Burger C, Berthold T, Von Schulthess GK, Buck A. Artifacts at PET and PET/CT caused by metallic hip prosthetic material. Radiology2003; 226:577–584.
  • 3 ShrevePD, Anzai Y, Wahl RL. Pitfalls in oncologic diagnosis with FDG-PET imaging: physiologic and benign variants. RadioGraphics1999; 19:61–77.
  • 4 CohadeC, Osman M, Pannu HK, Wahl RL. Uptake in supraclavicular area fat (“USA-Fat”): description on 18F-FDG PET/CT. J Nucl Med2003; 44:170–176.
  • 5 ChanderS, Meltzer CC, McCook BM. Physiologic uterine uptake of FDG during menstruation demonstrated with serial combined positron emission tomography and computed tomography. Clin Nucl Med2002; 27:22–24.
  • 6 NakamotoY, Tatsumi M, Hammoud D, Cohade C, Osman MM, Wahl RL. Normal FDG distribution patterns in the head and neck: PET/CT evaluation. Radiology2005; 234:879–885.
  • 7 VitolaJ, Delbeke D. Positron emission tomography for evaluation of colorectal carcinoma. Semin Roentgenol2002; 37:118–128.
  • 8 KosudaS, Kison PV, Greenough R, Grossman HB, Wahl RL. Preliminary assessment of fluorine-18 fluorodeoxyglucose positron emission tomography in patients with bladder cancer. Eur J Nucl Med1997; 24:615–620.
  • 9 ShrevePD, Grossman HB, Gross MD, Wahl RL. Metastatic prostate cancer: initial findings of PET with 2-deoxy-2-[F-18]fluoro-d-glucose. Radiology1996; 199:751–756.
  • 10 WahlRL. Why nearly all PET of abdominal and pelvic cancers will be performed as PET/CT. J Nucl Med2004; 45(suppl 1):82S–95S.
  • 11 HuebnerRH, Park KC, Shepherd JE, et al. A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancer. J Nucl Med2000; 41:1177–1189.
  • 12 SchiepersC, Penninckx F, De Vadder N, et al. Contribution of PET in the diagnosis of recurrent colorectal cancer: comparison with conventional imaging. Eur J Surg Oncol1995; 21:517–522.
  • 13 CohadeC, Osman M, Leal J, Wahl RL. Direct comparison of (18)F-FDG PET and PET/CT in patients with colorectal carcinoma. J Nucl Med2003; 44:1797–1803.
  • 14 WongTZ, Jones EL, Coleman RE. Positron emission tomography with 2-deoxy-2-[(18)F]fluoro-d-glucose for evaluating local and distant disease in patients with cervical cancer. Mol Imaging Biol2004; 6:55–62.
  • 15 RyuSY, Kim MH, Choi SC, Choi CW, Lee KH. Detection of early recurrence with 18F-FDG PET in patients with cervical cancer. J Nucl Med2003; 44:347–352.
  • 16 GrigsbyPW, Siegel BA, Dehdashti F, Rader J, Zoberi I. Posttherapy [18F] fluorodeoxyglucose positron emission tomography in carcinoma of the cervix: response and outcome. J Clin Oncol2004; 22:2167–2171.
  • 17 LinWC, Hung YC, Yeh LS, Kao CH, Yen RF, Shen YY. Usefulness of (18)F-fluorodeoxyglucose positron emission tomography to detect para-aortic lymph nodal metastasis in advanced cervical cancer with negative computed tomography findings. Gynecol Oncol2003; 89:73–76.
  • 18 YehLS, Hung YC, Shen YY, Kao CH, Lin CC, Lee CC. Detecting para-aortic lymph nodal metastasis by positron emission tomography of 18F-fluorodeoxyglucose in advanced cervical cancer with negative magnetic resonance imaging findings. Oncol Rep2002; 9:1289–1292.
  • 19 BelhocineT, De Barsy C, Hustinx R, Willems-Foidart J. Usefulness of (18)F-FDG PET in the post-therapy surveillance of endometrial carcinoma. Eur J Nucl Med Mol Imaging2002; 29: 1132–1139.
  • 20 SagaT, Higashi T, Ishimori T, et al. Clinical value of FDG-PET in the follow up of post-operative patients with endometrial cancer. Ann Nucl Med2003; 17:197–203.
  • 21 Garcia VellosoMJ, Boan Garcia JF, Villar Luque LM, Aramendia Beitia JM, Lopez Garcia G, Richter Echeverria JA. F-18-FDG positron emission tomography in the diagnosis of ovarian recurrence: comparison with CT scan and CA 125. Rev Esp Med Nucl2003; 22:217–223.
  • 22 ChoSM, Ha HK, Byun JY, et al. Usefulness of FDG PET for assessment of early recurrent epithelial ovarian cancer. AJR Am J Roentgenol2002; 179:391–395.
  • 23 BristowRE, del Carmen MG, Pannu HK, et al. Clinically occult recurrent ovarian cancer: patient selection for secondary cytoreductive surgery using combined PET/CT. Gynecol Oncol2003; 90: 519–528.
  • 24 PannuHK, Bristow RE, Cohade C, Fishman EK, Wahl RL. PET-CT in recurrent ovarian cancer: initial observations. RadioGraphics2004; 24:209–223.
  • 25 DrieskensO, Stroobants S, Gysen M, Vandenbosch G, Mortelmans L, Vergote I. Positron emission tomography with FDG in the detection of peritoneal and retroperitoneal metastases of ovarian cancer. Gynecol Obstet Invest2003; 55:130–134.
  • 26 YoshidaY, Kurokawa T, Kawahara K, et al. Incremental benefits of FDG positron emission tomography over CT alone for the preoperative staging of ovarian cancer. AJR Am J Roentgenol2004; 182:227–233.
  • 27 TurlakowA, Yeung HW, Salmon AS, Macapinlac HA, Larson SM. Peritoneal carcinomatosis: role of (18)F-FDG PET. J Nucl Med2003; 44:1407–1412.
  • 28 SchiepersC, Filmont JE, Czernin J. PET for staging of Hodgkin’s disease and non-Hodgkin’s lymphoma. Eur J Nucl Med Mol Imaging2003; 30(suppl 1):S82–S88.
  • 29 BarringtonSF, O’Doherty MJ. Limitations of PET for imaging lymphoma. Eur J Nucl Med Mol Imaging2003; 30(suppl 1):S117–S127.
  • 30 SchoderH, Larson SM, Yeung HW. PET/CT in oncology: integration into clinical management of lymphoma, melanoma, and gastrointestinal malignancies. J Nucl Med2004; 45(suppl 1):72S–81S.
  • 31 StraussLG. Fluorine-18 deoxyglucose and false-positive results: a major problem in the diagnostics of oncologic patients. Eur J Nucl Med1996; 23: 1409–1415.
  • 32 LermanH, 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 Med2004; 45:266–271.
  • 33 NakamotoY, Eisbruch A, Achtyes ED, et al. Prognostic value of positron emission tomography using F-18-fluorodeoxyglucose in patients with cervical cancer undergoing radiotherapy. Gynecol Oncol2002; 84:289–295.
  • 34 BhargavaP, Zhuang H, Kumar R, Charron M, Alavi A. Iatrogenic artifacts on whole-body F-18 FDG PET imaging. Clin Nucl Med2004; 29: 429–439.
  • 35 FayadL, Cohade C, Wahl RL, Fishman EK. Sacral fractures: a potential pitfall of FDG positron emission tomography. AJR Am J Roentgenol2003; 181:1239–1243.
  • 36 VesselleHJ, Miraldi FD. FDG PET of the retro-peritoneum: normal anatomy, variants, pathologic conditions, and strategies to avoid diagnostic pitfalls. RadioGraphics1998; 18:805–823.
  • 37 NakamotoY, Chin BB, Cohade C, Osman M, Tatsumi M, Wahl RL. PET/CT: artifacts caused by bowel motion. Nucl Med Commun2004; 25: 221–225.

Article History

Published in print: July 2005