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False-Negative Findings for Primary Lung Tumors on FDG Positron Emission Tomography: Staging and Prognostic Implications

Sendhil Kumar Cheran1, Nathan D. Nielsen1 and Edward F. Patz , Jr.2

1 School of Medicine, Duke University, Durham, NC 27710.
2 Department of Radiology, Duke University Medical Center, Box 3803, Durham, NC 27710.



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  		Fig. 1A. —68-year-old woman who presented with indeterminate right upper lobe nodule. Axial CT scan shows slightly lobular 1.3-cm right upper lobe nodule (arrow). No other abnormalities were identified.

 


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  		Fig. 1B. —68-year-old woman who presented with indeterminate right upper lobe nodule. Axial positron emission tomography scan in same region as A shows no significant uptake in nodule (arrow). Normal background mediastinal activity is minimal. Because of concern for malignancy, patient underwent surgical resection, and pathology revealed moderately differentiated adenocarcinoma.

 


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  		Fig. 2A. —71-year-old woman who presented with progressive heterogeneous opacities in lung. Axial CT scan shows scattered heterogeneous opacities with areas of more consolidation in left mid lung (arrow). Note poorly defined focal opacity in right mid lung.

 


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  		Fig. 2B. —71-year-old woman who presented with progressive heterogeneous opacities in lung. Coronal FDG positron emission tomography scan shows minimal uptake (arrow) in left lung equal to background mediastinal activity. Note normal activity in left ventricular myocardium (arrowhead). Bronchoscopy revealed bronchioalveolar cell carcinoma.

 

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