Pitfalls and artifacts in FDG oncologic PET/CT: A pictorial essay to the thoracic radiologist

Transcription

1 Pitfalls and artifacts in FDG oncologic PET/CT: A pictorial essay to the thoracic radiologist Poster No.: P-0120 Congress: ESTI 2015 Type: Scientific Poster Authors: G. Meirelles, J. Capobianco, M. Oliveira; Sao Paulo/BR Keywords: Neoplasia, Diagnostic procedure, PET-CT, PET, Thorax, Oncology DOI: /esti2015/P-0120 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 26

2 Purpose The main teaching points of this exhibit are: 1. To describe and illustrate the main pitfalls and artifacts in the interpretation of oncologic thoracic PET/CT examinations, including false-negative and falsepositive findings; 2. To present strategies for avoiding misinterpretation of common pitfalls and artifacts in oncologic thoracic PET/CT examinations. Page 2 of 26

3 Materials and Methods Normal 0 false false false PT-BR JA X-NONE PET/CT imaging is now an integral part of the management of patients with thoracic neoplasms, improving staging, therapy control and prognostic assessment of these patients. However, many artifacts and pitfalls can be seen on the examination, like normal variants, physiologic areas of 18F-fluoro-2-deoxy-D-glucose (FDG) uptake, acquisition or reconstruction artifacts, false-positive and false-negative findings. Page 3 of 26

4 Results Normal 0 false false false PT-BR JA X-NONE The main teaching points of this exhibit were to describe and illustrate the main pitfalls and artifacts in the interpretation of oncologic thoracic PET/CT examinations, including false-negative and false-positive findings, and to present strategies for avoiding misinterpretation of oncologic thoracic PET/CT examinations. The authors will illustrate the physiologic uptake of FDG, normal variants, artifacts (misregistration, truncation, FDG embolism and extravasation), potential pitfalls, like brown-fat FDG uptake, lipomatous hipertrophy of the interatrial septum, pleural uptake related to talc pleurodesis, radiationinduced injuries, iatrogenic causes of FDG uptake, muscular FDG uptake, FDG uptake induced by G-CSF and EPO, false-negative results (small lesions, mucinous tumors, adenocarcinomas in situ and minimally invasive tumors) and false-positive findings, such as infectious processes, atherosclerosis and granulomatous diseases (like sarcoid). Page 4 of 26

5 Images for this section: Fig. 1: Physiologic uptakes of FDG Page 5 of 26

6 Fig. 2: Physiologic uptakes of FDG Page 6 of 26

7 Fig. 3: Physiologic uptakes of FDG Page 7 of 26

8 Fig. 4: Brown fat Page 8 of 26

9 Fig. 5: Muscular FDG uptake Page 9 of 26

10 Fig. 6: Muscular FDG uptake Page 10 of 26

11 Fig. 7: Muscular FDG uptake Page 11 of 26

12 Fig. 8: False-positive: Infection Page 12 of 26

13 Fig. 9: False-positive: Infection Page 13 of 26

14 Fig. 10: False-positive: Infection Page 14 of 26

15 Fig. 11: False-positive: Benign Tumors Page 15 of 26

16 Fig. 12: False-positive: Benign Conditions Page 16 of 26

17 Fig. 13: False-positive: Benign Conditions Page 17 of 26

18 Fig. 14: False-positive: Benign Conditions Page 18 of 26

19 Fig. 15: False-positive: Post-surgical findings Page 19 of 26

20 Fig. 16: False-positive: Post-surgical findings Page 20 of 26

21 Fig. 17: False-positive: radiation-induced lesions Page 21 of 26

22 Fig. 18: Bone marrow uptake due to G-CSF Page 22 of 26

23 Fig. 19: Bone marrow uptake due to G-CSF Page 23 of 26

24 Fig. 20: Bone marrow uptake: EPO Page 24 of 26

25 Conclusions Normal 0 false false false PT-BR JA X-NONE Page 25 of 26

26 Personal Information Thanks for reading my exhibit. Please feel free to contact me at Page 26 of 26