Abstract
Since its introduction into clinical practice, multimodality imaging has revolutionized diagnostic imaging for both oncologic and non-oncologic pathologies. 18F-fluorodeoxyglucose (18F-FDG) PET/CT imaging which takes advantage of increased anaerobic glycolysis that occurs in tumor cells (Warburg effect) has gained significant clinical relevance in the management of most, if not all oncologic conditions. Because FDG is taken by both normal and abnormal tissues, PET/CT imaging may demonstrate several normal variants and imaging pitfalls. These may ultimately impact disease detection and diagnostic accuracy. Imaging specialists (nuclear medicine physicians and radiologists) must demonstrate a thorough understanding of normal and physiologic variants in the distribution of 18F-FDG; including potential imaging pitfalls and technical artifacts to minimize misinterpretation of images. The normal physiologic course of 18F-FDG results in a variable degree of uptake in the stomach, liver, spleen, small and large bowel. Urinary excretion results in renal, ureteric, and urinary bladder uptake. Technical artifacts can occur due to motion, truncation as well as the effects of contrast agents and metallic hardware. Using pictorial illustrations, this paper aims to describe the variants of physiologic 18F-FDG uptake that may mimic pathology as well as potential benign conditions that may result in misinterpretation of PET/CT images in common oncologic conditions of the abdomen and pelvis.
Highlights
The introduction of multimodality imaging into clinical practice has revolutionized diagnostic imaging for both oncologic and non-oncologic pathologies
Positron Emission Tomography combined with Computed Tomography (PET/CT) has become an essential hybrid imaging modality in oncology; playing a critical role in the detection, staging, assessment of treatment response, restaging and prognosis of a wide range of malignancies [1]
PET/CT hybrid imaging has the advantage of providing data from both physiological and anatomical changes at the same time
Summary
The introduction of multimodality imaging into clinical practice has revolutionized diagnostic imaging for both oncologic and non-oncologic pathologies. PET/CT hybrid imaging has the advantage of providing data from both physiological and anatomical changes at the same time. Many physiologic conditions, normal variants, and benign lesions within the pelvis and abdomen may cause uncertainty during image interpretation. The process of fusion of CT with PET for anatomical localization and attenuation correction can result in imaging artifacts. Variants and Pitfalls of PET/CT Imaging of the Abdomen and Pelvis mucinous tumors and indolent lymphomas can present a diagnostic challenge due to false-negative imaging results. Accurate reporting relies on a thorough understanding of normal and variant distribution of FDG, including potential technical artifacts and imaging pitfalls. Clinical history and examination are critical including information on previous surgery, fasting state, level of glycaemia, use of insulin and exposure to cold
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