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Focal FDG Uptake in Mediastinal Brown Fat Mimicking Malignancy: A Potential Pitfall Resolved on PET/CT

¹ All authors: Division of Diagnostic Imaging, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 57, Houston, TX 77030.

View larger version (83K): [in a new window]   Fig. 1. —12-year-old girl with hard palate cancer. Coronal 2D whole-body PET image shows increased FDG uptake (maximal standard uptake value, 20) in bilateral, symmetric, and elongated pattern in neck and shoulders that is consistent with uptake in brown fat. This characteristic pattern of FDG uptake is seldom confused with malignancy.

View larger version (110K): [in a new window]   Fig. 2A. —59-year-old woman with ovarian cancer. Axial images (coned view) of PET (A), unenhanced CT (B), and fused PET/CT (C) at level of aortic arch show increased FDG uptake (maximal standard uptake value, 4.3) in left prevascular region localized to adipose tissue (arrow). Note that in absence of CT correlation, uptake in this region could potentially have been misinterpreted as left internal mammary adenopathy.

View larger version (74K): [in a new window]   Fig. 2B. —59-year-old woman with ovarian cancer. Axial images (coned view) of PET (A), unenhanced CT (B), and fused PET/CT (C) at level of aortic arch show increased FDG uptake (maximal standard uptake value, 4.3) in left prevascular region localized to adipose tissue (arrow). Note that in absence of CT correlation, uptake in this region could potentially have been misinterpreted as left internal mammary adenopathy.

View larger version (118K): [in a new window]   Fig. 2C. —59-year-old woman with ovarian cancer. Axial images (coned view) of PET (A), unenhanced CT (B), and fused PET/CT (C) at level of aortic arch show increased FDG uptake (maximal standard uptake value, 4.3) in left prevascular region localized to adipose tissue (arrow). Note that in absence of CT correlation, uptake in this region could potentially have been misinterpreted as left internal mammary adenopathy.

View larger version (89K): [in a new window]   Fig. 3A. —57-year-old woman with esophageal cancer. Axial images of PET (A), unenhanced CT (B), and fused PET/CT (C) show increased FDG uptake (maximal standard uptake value, 4.8) in azygoesophageal recess localized to adipose tissue (arrows). Endoscopic sonography (not shown) performed in staging evaluation confirmed absence of locoregional nodal metastases. E = esophagus, asterisk = azygos vein.

View larger version (58K): [in a new window]   Fig. 3B. —57-year-old woman with esophageal cancer. Axial images of PET (A), unenhanced CT (B), and fused PET/CT (C) show increased FDG uptake (maximal standard uptake value, 4.8) in azygoesophageal recess localized to adipose tissue (arrows). Endoscopic sonography (not shown) performed in staging evaluation confirmed absence of locoregional nodal metastases. E = esophagus, asterisk = azygos vein.

View larger version (63K): [in a new window]   Fig. 3C. —57-year-old woman with esophageal cancer. Axial images of PET (A), unenhanced CT (B), and fused PET/CT (C) show increased FDG uptake (maximal standard uptake value, 4.8) in azygoesophageal recess localized to adipose tissue (arrows). Endoscopic sonography (not shown) performed in staging evaluation confirmed absence of locoregional nodal metastases. E = esophagus, asterisk = azygos vein.

View larger version (99K): [in a new window]   Fig. 4A. —79-year-old woman with esophageal cancer. Axial images of PET (A), unenhanced CT (B), and fused PET/CT (C) show increased FDG uptake (maximal standard uptake value [SUVmax], 9) in mediastinum localized to adipose tissue in interatrial septum (arrow). Note left paravertebral hypermetabolic brown fat (SUVmax, 5). LA = left atrium.

View larger version (68K): [in a new window]   Fig. 4B. —79-year-old woman with esophageal cancer. Axial images of PET (A), unenhanced CT (B), and fused PET/CT (C) show increased FDG uptake (maximal standard uptake value [SUVmax], 9) in mediastinum localized to adipose tissue in interatrial septum (arrow). Note left paravertebral hypermetabolic brown fat (SUVmax, 5). LA = left atrium.

View larger version (76K): [in a new window]   Fig. 4C. —79-year-old woman with esophageal cancer. Axial images of PET (A), unenhanced CT (B), and fused PET/CT (C) show increased FDG uptake (maximal standard uptake value [SUVmax], 9) in mediastinum localized to adipose tissue in interatrial septum (arrow). Note left paravertebral hypermetabolic brown fat (SUVmax, 5). LA = left atrium.

View larger version (93K): [in a new window]   Fig. 5A. —56-year-old woman with lung cancer. Axial images of PET (A), unenhanced CT (B), and fused PET/CT (C) obtained at level of origins of brachiocephalic arteries show increased FDG uptake (maximal standard uptake value [SUVmax], 8) in mediastinum localized to adipose tissue (arrows). Absence of mediastinal adenopathy was noted on 3-month follow-up CT. Note right paravertebral hypermetabolic brown fat (SUVmax, 5.3) in intercostal space. T = trachea, E = esophagus, SVC = superior vena cava, BA = brachiocephalic artery, LSA = left subclavian artery.

View larger version (54K): [in a new window]   Fig. 5B. —56-year-old woman with lung cancer. Axial images of PET (A), unenhanced CT (B), and fused PET/CT (C) obtained at level of origins of brachiocephalic arteries show increased FDG uptake (maximal standard uptake value [SUVmax], 8) in mediastinum localized to adipose tissue (arrows). Absence of mediastinal adenopathy was noted on 3-month follow-up CT. Note right paravertebral hypermetabolic brown fat (SUVmax, 5.3) in intercostal space. T = trachea, E = esophagus, SVC = superior vena cava, BA = brachiocephalic artery, LSA = left subclavian artery.

View larger version (63K): [in a new window]   Fig. 5C. —56-year-old woman with lung cancer. Axial images of PET (A), unenhanced CT (B), and fused PET/CT (C) obtained at level of origins of brachiocephalic arteries show increased FDG uptake (maximal standard uptake value [SUVmax], 8) in mediastinum localized to adipose tissue (arrows). Absence of mediastinal adenopathy was noted on 3-month follow-up CT. Note right paravertebral hypermetabolic brown fat (SUVmax, 5.3) in intercostal space. T = trachea, E = esophagus, SVC = superior vena cava, BA = brachiocephalic artery, LSA = left subclavian artery.

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