María José García VellosoServicio de Medicina NuclearClínica Universidad de Navarra

mjgarciave@unav.es

Pitfalls in FDG PET‐CT Imagingof the Chest

Sarajevo (Bosnia & Hercegovina)Wednesday, June 18 2014

10:40-11:20 a.m

• False negative– Tumors with low FDG metabolism:

• Mucinous lung adenocarcinoma• Lepidic pattern adenocarcinoma• Carcinoid Tumor

– Microscopic Disease

• False positive: inflammation/ infection– Tuberculsis, Granulomatosis, Sarcoidosis,

Aspergilosis, Histoplasmosis.– Pneumonía, Abscess– Pleurodesis– Reactive lymphadenopathy

FDG cellular metabolism

Paravertebral Abscess and spondylodiscitis(Staphilococcus Aureus)

SUVmax=8,4

58 year-old man with mass in upper right lobe, destruction of T3-T4

Hamartoma73-year-old man, Colorectal Cancer. SPN LUL

Pneumonia (Pneumocystis carinii and Staphilococcus aureus)

47-year-old woman, Breast Cancer. Neoadjuvant Therapy

Sarcoidosis

SUVmax=551-year-old woman with breast cancer. Neoadjuvant Therapy

SUVmax=5

Tuberculosis

SUVmax=9SUVmax=12

40-year-old man with pulmonary mass and subcarinal lymphadenopathy

Pneumoconiosis62-year-old man, ex-smoker. Asbestos exposure. Respiratory Infection, Lymphadenopaty in thorax.

Radiation-induced Pneumonitis39-year-old woman, Ovarian cancer recurrence.

Thoracothomy71-year-old man. Lung Adenocarcinoma, Surgery (1 month)

72-year-old man, 23 mm SPN in LUL

Lepidic pattern adenocarcinoma

SUV=0,95SUV=0,78

08/2013

SUV=0,98

03/2014

3 h. Dual-TimeΔSUV= 22%

1. Lung2. Pleura3. Lymph nodes4. Thymic gland5. Heart and vessels6. Esophagus7. Muscles8. Bones and joints9. Bone marrow

FDG PET-CT. Pitfalls

Pleural Metastasis70-year-old man, Lung adenocarcinoma treated

Talc Pleurodesis66-year-old woman Lung Adenocarcinoma stage IV treated

EmpyemaSUVmax=7,6 SUVmax=3,1SUVmax=11,8

68-year-old man, NSCLC LUL (14 cm) and lymphadenopathy

66-year-old man. CT: 2 cm SPN in RUL AdenocarcinomapT1 pN2 (4R)

SUVmax=3,3

cT1 N0

Mononucleosis35-year-old woman, suspected lymphoma

SUVmax N1=3,4

SUVmax=6,4

SUVmax N2=3,6 EBUS FP

Squamous cell Ca.pT1a N0

71-year-old man.CT: 17 mm SPN in RUL

Hyperplasia Thymus

Thymus NHL

Atrial Fibrillation69-year-old-man, NSCLC, Chemo-Radiotherapy

64-year-old man, Bladder Ca. SPN in RUL

Esophagus

Esophagitis

Esophagus

Gastroesophageal RefluxNeoplasia Esophagitis

Brown FatUSA Fat

NHL refractary to Chemotherapy

Acute Fracture

51-year-old man, SPN in LLL.

Paget Disease

Acute Fracture