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Incidental Findings on Integrated PET/CT That Do Not Accumulate 18F-FDG

John F. Bruzzi1, Mylene T. Truong1, Edith M. Marom1, Osama Mawlawi1, Donald A. Podoloff1, Homer A. Macapinlac1 and Reginald F. Munden1

1 All authors: Department of Thoracic Imaging, M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 0371, Houston, TX 77030-4095.


Figure 1
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  		Fig. 1A —67-year-old man with non-small cell lung cancer and incidental left renal mass detected at staging PET/CT. Axial unenhanced CT image (3.75-mm slice thickness) from staging PET/CT scan shows hypodense mass in interpolar region of left kidney (arrow) that was not clearly simple cyst and was suspicious for renal malignancy. Area had not been included in initial diagnostic chest CT scan.

 

Figure 2
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  		Fig. 1B —67-year-old man with non-small cell lung cancer and incidental left renal mass detected at staging PET/CT. Correlative PET shows no increased 18F-FDG uptake within mass compared with adjacent renal cortex (arrow). Further evaluation of this lesion was recommended on basis of CT appearance.

 

Figure 3
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  		Fig. 1C —67-year-old man with non-small cell lung cancer and incidental left renal mass detected at staging PET/CT. Fused PET/CT image corresponding to B shows no increased 18F-FDG uptake within mass compared with adjacent renal cortex (arrow). Focus of abnormally increased uptake of 18F-FDG (arrowhead) in L3 vertebral body is consistent with bone metastasis.

 

Figure 4
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  		Fig. 1D —67-year-old man with non-small cell lung cancer and incidental left renal mass detected at staging PET/CT. Enhanced CT scan of abdomen obtained after A-C confirms presence of heterogeneously enhancing left renal mass (arrow) suspicious for malignancy. Subsequent biopsy revealed renal metastasis.

 

Figure 5
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  		Fig. 2A —Brain of 65-year-old man with progressive non-small cell lung cancer. Unenhanced CT image from staging PET/CT study shows area of vasogenic edema (arrow) in right parietal lobe of brain with evidence of mild compressive mass effect on right lateral ventricle. There had been no clinical suspicion of metastasis to brain.

 

Figure 6
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  		Fig. 2B —Brain of 65-year-old man with progressive non-small cell lung cancer. Correlative PET image shows normal symmetric cortical activity and area of vasogenic edema (arrow).

 

Figure 7
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  		Fig. 2C —Brain of 65-year-old man with progressive non-small cell lung cancer. Fused PET/CT image corresponding to B shows normal symmetric cortical activity and area of vasogenic edema (arrow).

 

Figure 8
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  		Fig. 2D —Brain of 65-year-old man with progressive non-small cell lung cancer. Gadolinium-enhanced T1-weighted image in axial plane (TR/TE, 600/8) confirms presence of enhancing cortical nodule (arrow) in parietal lobe consistent with cerebral metastasis. Lesion was subsequently managed with stereotactic radiosurgery.

 

Figure 9
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  		Fig. 3A —67-year-old woman with non-small cell lung cancer treated for 4 months with chemotherapy who complained of worsening lower back pain. Unenhanced CT image from initial PET/CT study shows mixed lytic and blastic lesion (arrow) of vertebral body.

 

Figure 10
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  		Fig. 3B —67-year-old woman with non-small cell lung cancer treated for 4 months with chemotherapy who complained of worsening lower back pain. Fused PET/CT image shows no activity in T11 vertebral body (arrow). Accumulation of 18F-FDG (arrowhead) in adjacent lung parenchyma represents persistent metabolic activity in primary lung carcinoma.

 

Figure 11
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  		Fig. 3C —67-year-old woman with non-small cell lung cancer treated for 4 months with chemotherapy who complained of worsening lower back pain. Sagittal T2-weighted MR image (TR/TE, 3,800/97) of spine confirms presence of metastasis (arrow) to T11 without evidence of extension into spinal cord.

 

Figure 12
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  		Fig. 3D —67-year-old woman with non-small cell lung cancer treated for 4 months with chemotherapy who complained of worsening lower back pain. Sagittal T2-weighted image (3,800/97) from MRI scan obtained 4 months after C shows progression of metastasis resulting in compression fracture (arrow) of T11 vertebral body and extension of tumor into extradural space, impinging on spinal cord.

 

Figure 13
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  		Fig. 4A —57-year-old woman with metastatic non-small cell lung cancer. Example of abnormality detected at PET/CT of non-small cell lung cancer that did not show increased 18F-FDG uptake and that was only evident on CT images. Axial unenhanced CT scan depicts classic appearance of fat-containing dermoid cyst (arrow) in pelvis.

 

Figure 14
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  		Fig. 4B —57-year-old woman with metastatic non-small cell lung cancer. Example of abnormality detected at PET/CT of non-small cell lung cancer that did not show increased 18F-FDG uptake and that was only evident on CT images. Correlative PET image shows no 18F-FDG uptake within lesion (arrow). Although dermoid cyst remained asymptomatic, early detection of cyst with PET/CT may have provided important additional information in event of subsequent complications from torsion or hemorrhage of cyst resulting in abdominal pain.

 

Figure 15
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  		Fig. 4C —57-year-old woman with metastatic non-small cell lung cancer. Example of abnormality detected at PET/CT of non-small cell lung cancer that did not show increased 18F-FDG uptake and that was only evident on CT images. Fused PET/CT image corresponding to B shows no uptake in lesion (arrow).

 

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