FDG-PET/CT pitfalls in gynecological and genitourinary oncological imaging

Abstract

The role of whole-body positron emission tomography(PET)/ computed tomography (CT) with fluorodeoxyglucose (FDG) is now established in the assessment of many gynecologic and genitourinary malignant tumors. FDG PET/CT has been widely adopted for staging assessments in patients with suspected advanced disease, in cases of suspected disease recurrence, and for determining prognosis in a number of malignancies. A number of pitfalls are commonly encountered when reviewing FDG PET/CT scans in gynecologic and genitourinary cases; these pitfalls can be classified into those that yield potential false- positive or false- negative results. Potential false positives include physiologic uptake of FDG by the endometrium and ovaries in premenopausal patients, physiologic renal excretion of FDG into the ureters and the urinary bladder, and increased FDG activity in benign conditions such as uterine fibroids, pelvic inflammatory disease, and benign endometriotic cysts. Potential false negatives include low-level FDG uptake by necrotic, mucinous, cystic, or low-grade tumors and the masking of serosal and peritoneal disease by adjacent physiologic bowel or bladder activity. In addition, there are inherent technical limitations- such as motion artifact (from respiratory motion and bowel peristalsis) and the limited spatial resolution of PET-that may limit the assessment of small-volume malignant disease. Knowledge of the key imaging features of physiologic and nonphysiologic FDG uptake, in addition to understanding the principles of adequate patient preparation and PET scanning protocols, is important for accurate interpretation of gynecologic and genitourinary oncologic FDG PET/CT studies. (C) RSNA, 2017 center dot radiographics. rsna. org