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Brain Abnormalities Detected on Whole-Body ¹⁸F-FDG PET in Cancer Patients: Spectrum of Findings

¹ Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157.
² Department of Radiology, University of Utah Health Sciences Center, Salt Lake City, UT 84132.

View larger version (75K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —70-year-old woman with non-small cell lung cancer and extensive thoracic and abdominal metastases. Anterior maximal-intensity-projection (MIP) PET image with window settings optimized to show abnormalities in chest, abdomen, and pelvis shows numerous foci of increased 18F-FDG activity in thorax and abdomen, which is consistent with diffuse metastatic lung cancer. FDG activity in brain appears within normal limits.

View larger version (62K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —70-year-old woman with non-small cell lung cancer and extensive thoracic and abdominal metastases. Anterior MIP PET image after window settings were adjusted to optimize visualization of abnormalities in brain reveals small focus of increased FDG activity in right temporal lobe (arrow), which is consistent with brain metastasis.

View larger version (64K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —55-year-old man with non-small cell lung cancer. Sagittal PET image shows foci of increased 18F-FDG activity in mediastinal lymph nodes (arrow). Heterogeneous FDG activity in brain (arrowhead) is suspicious for metastatic disease.

View larger version (67K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —55-year-old man with non-small cell lung cancer. Sagittal PET image after window settings were adjusted shows several foci of abnormal 18F-FDG activity in brain. Two lesions show central photopenia (arrows), which is consistent with necrosis. Biopsy confirmed non-small cell lung cancer and necrosis.

View larger version (55K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —48-year-old man with non-small cell lung cancer. Coronal PET image shows small focus of increased 18F-FDG activity in left upper lobe (arrow), which is consistent with patient's known lung cancer. FDG activity in brain appears within normal limits.

View larger version (52K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —48-year-old man with non-small cell lung cancer. Coronal PET image after window settings were adjusted shows small focus of increased FDG activity in left cerebellum (arrow) that is suspicious for new metastatic disease.

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —48-year-old man with non-small cell lung cancer. Axial T1-weighted MR image obtained with contrast material shows focus of enhancement (arrow) corresponding to that shown on PET (B) and confirms diagnosis of cerebellar metastasis.

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —59-year-old woman with metastatic breast carcinoma who presented for follow-up examination after right mastectomy, chemotherapy, and radiation therapy. Posterior maximal-intensity-projection (MIP) PET image shows liver metastasis (arrow) and multiple bone metastatic lesions (arrowheads). Note 18F-FDG activity in brain appears within normal limits.

View larger version (70K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —59-year-old woman with metastatic breast carcinoma who presented for follow-up examination after right mastectomy, chemotherapy, and radiation therapy. Posterior MIP PET image after window settings were adjusted to optimize visualization of brain abnormalities shows small focus of increased FDG activity in right cerebellum (arrow), which is consistent with new metastatic disease.

View larger version (75K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —55-year-old woman with diffuse large B-cell lymphoma. Sagittal PET image shows focus of increased 18F-FDG activity in brainstem (arrow).

View larger version (63K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —55-year-old woman with diffuse large B-cell lymphoma. Axial PET image shows brainstem focus (arrow) as seen in A in addition to focus of increased activity in left temporal lobe (arrowhead).

View larger version (133K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —55-year-old woman with diffuse large B-cell lymphoma. Axial spin-echo MR image obtained with contrast material shows enhancement in brainstem (arrow) and left temporal lobe (arrowhead). Biopsy confirmed large B-cell lymphoma.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —79-year-old man with melanoma. Coronal T1-weighted MR image shows subcentimeter focus of enhancement (arrow), which is consistent with metastasis.

View larger version (71K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —79-year-old man with melanoma. Coronal PET image depicts normal 18F-FDG activity likely because this lesion (arrow) is at limits of PET resolution. This lesion was treated with gamma knife radiation therapy.

View larger version (163K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —70-year-old man with poorly differentiated metastatic brain neoplasm of unknown primary cancer. Coronal T1-weighted MR image shows enhancing lesion in left inferior parietal lobe (arrow).

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —70-year-old man with poorly differentiated metastatic brain neoplasm of unknown primary cancer. Coronal PET image shows focus of increased 18F-FDG activity in left inferior parietal lobe (arrow).

View larger version (86K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —70-year-old man with poorly differentiated metastatic brain neoplasm of unknown primary cancer. Coronal PET image of thorax shows small focus of increased FDG activity in right upper lobe (arrow). Biopsy confirmed bronchogenic carcinoma.

View larger version (79K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —49-year-old woman with non-small cell lung cancer and brain metastases who presented for follow-up examination after craniotomy and resection of left parietal lobe lesion. Axial PET image shows photopenia (arrow) in left parietal lobe with normal 18F-FDG activity in surrounding gray matter.

View larger version (165K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —49-year-old woman with non-small cell lung cancer and brain metastases who presented for follow-up examination after craniotomy and resection of left parietal lobe lesion. Axial spin-echo MR image shows postsurgical changes (arrow) after left parietal craniotomy.

View larger version (85K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —65-year-old man with melanoma who presented for follow-up examination after craniotomy and resection of left frontoparietal metastatic lesion. Sagittal (A) and coronal (B) PET images show photopenia (arrows) in left frontoparietal region with normal 18F-FDG activity in surrounding gray matter. C, Coronal T1-weighted MR image obtained with contrast material shows postcraniotomy changes (arrow).

View larger version (89K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —65-year-old man with melanoma who presented for follow-up examination after craniotomy and resection of left frontoparietal metastatic lesion. Sagittal (A) and coronal (B) PET images show photopenia (arrows) in left frontoparietal region with normal 18F-FDG activity in surrounding gray matter.

View larger version (166K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9C —65-year-old man with melanoma who presented for follow-up examination after craniotomy and resection of left frontoparietal metastatic lesion. Coronal T1-weighted MR image obtained with contrast material shows postcraniotomy changes (arrow).

View larger version (53K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —77-year-old man with metastatic non-small cell lung cancer and primary renal cell carcinoma. Axial (A) and sagittal (B) PET images show displacement of cerebellar hemispheres (arrowheads) by midline photopenic defect (arrows).

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —77-year-old man with metastatic non-small cell lung cancer and primary renal cell carcinoma. Axial (A) and sagittal (B) PET images show displacement of cerebellar hemispheres (arrowheads) by midline photopenic defect (arrows).

View larger version (77K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10C —77-year-old man with metastatic non-small cell lung cancer and primary renal cell carcinoma. Unenhanced axial (C) and sagittal (D) CT images show collection of CSF-attenuation fluid with nonenhancing borders in posterior fossa (arrows) that is consistent with retrocerebellar arachnoid cyst.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10D —77-year-old man with metastatic non-small cell lung cancer and primary renal cell carcinoma. Unenhanced axial (C) and sagittal (D) CT images show collection of CSF-attenuation fluid with nonenhancing borders in posterior fossa (arrows) that is consistent with retrocerebellar arachnoid cyst.

View larger version (61K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11A —48-year-old man with metastatic melanoma. Coronal PET image shows enlarged photopenic ventricles (arrow) surrounded by normal 18F-FDG activity in compressed gray matter (arrowhead).

View larger version (184K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11B —48-year-old man with metastatic melanoma. Coronal FLAIR MR image shows ventriculomegaly (arrow), which is consistent with patient's history of communicating hydrocephalus.

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12A —64-year-old man with non-small cell lung cancer. Axial PET image shows mildly asymmetric increased 18F-FDG activity in left parietooccipital region (arrow).

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12B —64-year-old man with non-small cell lung cancer. Axial T1-weighted MR image obtained with contrast material shows corresponding hemorrhagic mass (arrow), which is consistent with metastasis.

View larger version (93K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13A —67-year-old man with non-small cell lung cancer. Axial PET image shows large focus of decreased 18F-FDG activity in left frontal lobe (arrow).

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13B —67-year-old man with non-small cell lung cancer. Axial T1-weighted MR image shows corresponding area of encephalomalacia (arrow) that is consistent with prior cerebrovascular infarction.

View larger version (59K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14A —67-year-old woman with non-small cell lung cancer. Axial PET image shows 18F-FDG activity in cerebellum (arrow) that is within normal limits.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14B —67-year-old woman with non-small cell lung cancer. Obtained 1 year after A, axial PET image shows focus of photopenia (arrow) in mid right cerebellar hemisphere that is consistent with previously undiagnosed cerebrovascular infarction. Previously diagnosed remote cerebrovascular infarction (arrowhead) is also evident in left parietal lobe.

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