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Focal Parenchymal Lung Lesions Showing a Potential of False-Positive and False-Negative Interpretations on Integrated PET/CT

Sung Shine Shim1, Kyung Soo Lee1, Byung-Tae Kim2, Joon Young Choi2, Myung Jin Chung1 and Eun Jeong Lee2

1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Kangnam-gu, Seoul 135-710, Korea.
2 Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.


Figure 1
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  		Fig. 1A —Pulmonary tuberculosis in 44-year-old man. Mediastinal window of enhanced CT scan (5.0-mm collimation) obtained at level of suprahepatic inferior vena cava shows masslike consolidation in left lower lobe.

 

Figure 2
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  		Fig. 1B —Pulmonary tuberculosis in 44-year-old man. Markedly increased 18F-FDG uptake (arrow) is observed in lesion on PET image (peak standardized uptake value = 22.0).

 

Figure 3
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  		Fig. 2A —Actinomycosis in 48-year-old man. Lung window of thin-section CT scan (2.5-mm collimation) obtained at level of great vessels shows 5.6-cm masslike consolidation in left upper lobe.

 

Figure 4
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  		Fig. 2B —Actinomycosis in 48-year-old man. Significantly increased 18F-FDG uptake (peak standardized uptake value = 16.5) is noted in lesion of left upper lobe on PET (B) and integrated PET/CT (C) images. Small focus of activity (arrow, B) medial to main lesion is also portion of inflammatory lesion, which could be connected to main lesion on inferior images.

 

Figure 5
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  		Fig. 2C —Actinomycosis in 48-year-old man. Significantly increased 18F-FDG uptake (peak standardized uptake value = 16.5) is noted in lesion of left upper lobe on PET (B) and integrated PET/CT (C) images. Small focus of activity (arrow, B) medial to main lesion is also portion of inflammatory lesion, which could be connected to main lesion on inferior images.

 

Figure 6
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  		Fig. 3A —Lung abscess in 72-year-old woman. Mediastinal window of enhanced CT scan (5.0-mm collimation) obtained at subcarinal level shows 4-cm subpleural necrotic mass in right upper lobe. Also note right hilar lymph node enlargement (arrow).

 

Figure 7
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  		Fig. 3B —Lung abscess in 72-year-old woman. Markedly increased 18F-FDG uptake in parenchymal right upper lobar lesion (peak standardized uptake value [SUV] = 13.5) and in right hilar lymph node (arrow) (peak SUV = 6.5) is noticed on PET image.

 

Figure 8
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  		Fig. 4A —Coccidioidomycosis in 58-year-old man. Lung window of CT scan (4.0-mm collimation, 80 mA) obtained at level of left lower lobar bronchus shows masslike consolidation in right middle and lower lobes. Also note enlarged lymph nodes (arrow) in subcarinal area.

 

Figure 9
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  		Fig. 4B —Coccidioidomycosis in 58-year-old man. Integrated PET/CT scan clearly shows high 18F-FDG uptake (peak standardized uptake value [SUV] = 9.6) in parenchymal lung lesions and in subcarinal (peak SUV = 10.4) lymph nodes (arrow).

 

Figure 10
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  		Fig. 5A —Paragonimus westermani infestation in 46-year-old man. Mediastinal window of CT scan (5.0-mm collimation) obtained at subcarinal level shows 2.6-cm low-attenuation nodule (arrow) at bottom of right upper lobe.

 

Figure 11
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  		Fig. 5B —Paragonimus westermani infestation in 46-year-old man. Increased 18F-FDG uptake (peak standardized uptake value = 8.1) (arrow, C) is noted in nodule both on PET (B) and integrated PET/CT (C) images.

 

Figure 12
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  		Fig. 5C —Paragonimus westermani infestation in 46-year-old man. Increased 18F-FDG uptake (peak standardized uptake value = 8.1) (arrow, C) is noted in nodule both on PET (B) and integrated PET/CT (C) images.

 

Figure 13
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  		Fig. 6A —Sarcoidosis in 48-year-old man. Mediastinal window of unenhanced CT scan (7.0-mm collimation) obtained at level of bronchus intermedius shows 13-mm hilar lymph nodes (arrows) bilaterally.

 

Figure 14
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  		Fig. 6B —Sarcoidosis in 48-year-old man. Areas of increased 18F-FDG uptake (arrows) are seen on PET image (peak standardized uptake value = 4.8 in right hilum, 3.5 in left hilum).

 

Figure 15
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  		Fig. 7A —Pneumoconiosis and progressive massive fibrosis in 59-year-old man who worked in coal mine for 20 years. Lung window of CT scan (5.0-mm collimation) obtained at level of aortic arch shows two poorly defined masses, one each in right and left upper lobes. Also note right pneumothorax caused by percutaneous needle biopsy of mass in right upper lobe.

 

Figure 16
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  		Fig. 7B —Pneumoconiosis and progressive massive fibrosis in 59-year-old man who worked in coal mine for 20 years. Areas of increased 18F-FDG uptake (arrows) (peak standardized uptake value [SUV] = 11.1) are noted in masses of both upper lobes on transaxial (B) and coronal (C) images of integrated PET/CT. Also note increased uptake in right paratracheal node (arrowhead, B) (peak SUV = 11.0).

 

Figure 17
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  		Fig. 7C —Pneumoconiosis and progressive massive fibrosis in 59-year-old man who worked in coal mine for 20 years. Areas of increased 18F-FDG uptake (arrows) (peak standardized uptake value [SUV] = 11.1) are noted in masses of both upper lobes on transaxial (B) and coronal (C) images of integrated PET/CT. Also note increased uptake in right paratracheal node (arrowhead, B) (peak SUV = 11.0).

 

Figure 18
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  		Fig. 8A —Sclerosing hemangioma in 40-year-old woman. Mediastinal window of enhanced CT scan (5.0-mm collimation) obtained at level of right middle lobar bronchus shows 2.2-cm enhancing nodule (arrow) in right middle lobe.

 

Figure 19
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  		Fig. 8B —Sclerosing hemangioma in 40-year-old woman. High 18F-FDG uptake (arrow) (peak standardized uptake value = 5.3) is seen on PET image.

 

Figure 20
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  		Fig. 9A —Inflammatory pseudotumor in 70-year-old-woman. Lung window of CT scan (5.0-mm collimation) obtained at level of basal segmental bronchus shows 2.5-cm well-defined nodule in left lower lobe.

 

Figure 21
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  		Fig. 9B —Inflammatory pseudotumor in 70-year-old-woman. Abnormally increased 18F-FDG uptake (arrow, C) (peak standardized uptake value = 6.4) is seen on both PET (B) and integrated PET/CT (C) images.

 

Figure 22
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  		Fig. 9C —Inflammatory pseudotumor in 70-year-old-woman. Abnormally increased 18F-FDG uptake (arrow, C) (peak standardized uptake value = 6.4) is seen on both PET (B) and integrated PET/CT (C) images.

 

Figure 23
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  		Fig. 10A —Adenocarcinoma with predominantly mucinous bronchioloalveolar carcinoma component in 48-year-old man. Lung window of thin-section CT scan (2.5-mm collimation) obtained at level of azygous arch shows 2.1-cm nodule (arrow) containing internal bubble radiolucencies with lobulated and spiculated margin in left upper lobe.

 

Figure 24
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  		Fig. 10B —Adenocarcinoma with predominantly mucinous bronchioloalveolar carcinoma component in 48-year-old man. Little 18F-FDG uptake (straight arrows) in lesion shown in A is noted on PET (B) and integrated PET/CT (C) images. Mediastinal node uptakes (curved arrows) were due to benign node uptake: follicular hyperplasia with fibrotic nodule formation and anthracotic change on histopathologic examination. Small focus of activity (arrowhead, B) medial to lung cancer in B corresponds to vascular uptake in left upper lobar pulmonary artery branch.

 

Figure 25
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  		Fig. 10C —Adenocarcinoma with predominantly mucinous bronchioloalveolar carcinoma component in 48-year-old man. Little 18F-FDG uptake (straight arrows) in lesion shown in A is noted on PET (B) and integrated PET/CT (C) images. Mediastinal node uptakes (curved arrows) were due to benign node uptake: follicular hyperplasia with fibrotic nodule formation and anthracotic change on histopathologic examination. Small focus of activity (arrowhead, B) medial to lung cancer in B corresponds to vascular uptake in left upper lobar pulmonary artery branch.

 

Figure 26
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  		Fig. 11A —Carcinoid tumor in 56-year-old man. Mediastinal window of enhanced CT scan (5.0-mm collimation) obtained at level of left atrium shows 41-mm moderately enhancing homogeneous mass in right lower lobe.

 

Figure 27
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  		Fig. 11B —Carcinoid tumor in 56-year-old man. Mass shows little 18F-FDG uptake (arrows) on PET image.

 

Figure 28
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  		Fig. 12A —Mucoepidermoid carcinoma in 64-year-old woman. Coronal reformation image of enhanced CT scan (2.5-mm collimation) shows nonenhancing endobronchial nodule (arrow) in left lower lobar bronchus.

 

Figure 29
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  		Fig. 12B —Mucoepidermoid carcinoma in 64-year-old woman. No 18F-FDG uptake (arrow, C) is noted on coronal PET (B) and integrated PET/CT (C) images.

 

Figure 30
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  		Fig. 12C —Mucoepidermoid carcinoma in 64-year-old woman. No 18F-FDG uptake (arrow, C) is noted on coronal PET (B) and integrated PET/CT (C) images.

 

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