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Benign Nonphysiologic Lesions with Increased ¹⁸F-FDG Uptake on PET/CT: Characterization and Incidence

¹ Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, 6 Weizman St., Tel-Aviv 64239, Israel.
² Department of Radiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv, Israel.

View larger version (63K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Composite figure of three patients showing mild, moderate, or marked uptake of 18F-FDG in benign lesions as compared with background activity. CT (A), PET (B), and fused PET/CT (C) images show marked uptake of FDG (arrows) (maximum standardized uptake value = 8.1) in 57-year-old woman with histologically proven bronchiolitis obliterans with organizing pneumonia.

View larger version (82K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Composite figure of three patients showing mild, moderate, or marked uptake of 18F-FDG in benign lesions as compared with background activity. CT (A), PET (B), and fused PET/CT (C) images show marked uptake of FDG (arrows) (maximum standardized uptake value = 8.1) in 57-year-old woman with histologically proven bronchiolitis obliterans with organizing pneumonia.

View larger version (43K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Composite figure of three patients showing mild, moderate, or marked uptake of 18F-FDG in benign lesions as compared with background activity. CT (A), PET (B), and fused PET/CT (C) images show marked uptake of FDG (arrows) (maximum standardized uptake value = 8.1) in 57-year-old woman with histologically proven bronchiolitis obliterans with organizing pneumonia.

View larger version (93K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Composite figure of three patients showing mild, moderate, or marked uptake of 18F-FDG in benign lesions as compared with background activity. CT (A), PET (B), and fused PET/CT (C) images show moderate uptake of FDG (arrows) in 50-year-old man with left adrenal adenoma that was stable for more than 2 years.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —Composite figure of three patients showing mild, moderate, or marked uptake of 18F-FDG in benign lesions as compared with background activity. CT (A), PET (B), and fused PET/CT (C) images show moderate uptake of FDG (arrows) in 50-year-old man with left adrenal adenoma that was stable for more than 2 years.

View larger version (66K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1F —Composite figure of three patients showing mild, moderate, or marked uptake of 18F-FDG in benign lesions as compared with background activity. CT (A), PET (B), and fused PET/CT (C) images show moderate uptake of FDG (arrows) in 50-year-old man with left adrenal adenoma that was stable for more than 2 years.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1G —Composite figure of three patients showing mild, moderate, or marked uptake of 18F-FDG in benign lesions as compared with background activity. CT (G), PET (H), fused PET/CT (I), and correlative fat-suppressed T2-weighted MR (J) images show mild uptake of FDG (arrows, H–J) in 56-year-old woman with neurofibroma involving C6–C7 nerve root.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1H —Composite figure of three patients showing mild, moderate, or marked uptake of 18F-FDG in benign lesions as compared with background activity. CT (G), PET (H), fused PET/CT (I), and correlative fat-suppressed T2-weighted MR (J) images show mild uptake of FDG (arrows, H–J) in 56-year-old woman with neurofibroma involving C6–C7 nerve root.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1I —Composite figure of three patients showing mild, moderate, or marked uptake of 18F-FDG in benign lesions as compared with background activity. CT (G), PET (H), fused PET/CT (I), and correlative fat-suppressed T2-weighted MR (J) images show mild uptake of FDG (arrows, H–J) in 56-year-old woman with neurofibroma involving C6–C7 nerve root.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1J —Composite figure of three patients showing mild, moderate, or marked uptake of 18F-FDG in benign lesions as compared with background activity. CT (G), PET (H), fused PET/CT (I), and correlative fat-suppressed T2-weighted MR (J) images show mild uptake of FDG (arrows, H–J) in 56-year-old woman with neurofibroma involving C6–C7 nerve root.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Benign pattern suggested on both CT and PET in 41-year-old man with Crohn's disease. CT (A), PET (B), and fused PET/CT (C) images show marked uptake of 18F-FDG in long segment of concentrically thickened distal ileum (arrows) with submucosal deposition of fat, which is suggestive of inflammatory bowel disease. Crohn's disease was confirmed on histology.

View larger version (65K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Benign pattern suggested on both CT and PET in 41-year-old man with Crohn's disease. CT (A), PET (B), and fused PET/CT (C) images show marked uptake of 18F-FDG in long segment of concentrically thickened distal ileum (arrows) with submucosal deposition of fat, which is suggestive of inflammatory bowel disease. Crohn's disease was confirmed on histology.

View larger version (61K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Benign pattern suggested on both CT and PET in 41-year-old man with Crohn's disease. CT (A), PET (B), and fused PET/CT (C) images show marked uptake of 18F-FDG in long segment of concentrically thickened distal ileum (arrows) with submucosal deposition of fat, which is suggestive of inflammatory bowel disease. Crohn's disease was confirmed on histology.

View larger version (86K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —CT pattern suggestive of benign diagnosis. CT (A), PET (B), and fused PET/CT (C) images show abnormal uptake of 18F-FDG in enlarged distal external iliac node (arrows) on right in 52-year-old man with lymphoma. Focal abnormal uptake of FDG in left groin (arrowheads) is localized on CT to iliopsoas tendon, which is consistent with tendinosis.

View larger version (62K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —CT pattern suggestive of benign diagnosis. CT (A), PET (B), and fused PET/CT (C) images show abnormal uptake of 18F-FDG in enlarged distal external iliac node (arrows) on right in 52-year-old man with lymphoma. Focal abnormal uptake of FDG in left groin (arrowheads) is localized on CT to iliopsoas tendon, which is consistent with tendinosis.

View larger version (61K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —CT pattern suggestive of benign diagnosis. CT (A), PET (B), and fused PET/CT (C) images show abnormal uptake of 18F-FDG in enlarged distal external iliac node (arrows) on right in 52-year-old man with lymphoma. Focal abnormal uptake of FDG in left groin (arrowheads) is localized on CT to iliopsoas tendon, which is consistent with tendinosis.

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —CT pattern suggestive of benign diagnosis. CT (D), PET (E), and fused PET/CT (F) images show focal uptake of FDG in left flank (arrows) in 70-year-old man. Fused PET/CT image (F) shows uptake to be in small soft-tissue-attenuation mass with fat-attenuation center suggestive of fat necrosis, which was proven histologically.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —CT pattern suggestive of benign diagnosis. CT (D), PET (E), and fused PET/CT (F) images show focal uptake of FDG in left flank (arrows) in 70-year-old man. Fused PET/CT image (F) shows uptake to be in small soft-tissue-attenuation mass with fat-attenuation center suggestive of fat necrosis, which was proven histologically.

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3F —CT pattern suggestive of benign diagnosis. CT (D), PET (E), and fused PET/CT (F) images show focal uptake of FDG in left flank (arrows) in 70-year-old man. Fused PET/CT image (F) shows uptake to be in small soft-tissue-attenuation mass with fat-attenuation center suggestive of fat necrosis, which was proven histologically.

View larger version (71K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —PET pattern suggestive of benign diagnosis in 57-year-old woman. PET image shows diffuse uptake of 18F-FDG in left shoulder that is suggestive of synovitis.

View larger version (82K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Histologic diagnosis necessary to define benign lesion in 59-year-old man. CT (A), PET (B), and fused PET/CT (C) images show abnormal uptake of 18F-FDG in polypoid lesion (arrows) along right wall of rectum. Resected specimen (not shown) revealed tubulovillous adenoma with no evidence of malignancy.

View larger version (64K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Histologic diagnosis necessary to define benign lesion in 59-year-old man. CT (A), PET (B), and fused PET/CT (C) images show abnormal uptake of 18F-FDG in polypoid lesion (arrows) along right wall of rectum. Resected specimen (not shown) revealed tubulovillous adenoma with no evidence of malignancy.

View larger version (58K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —Histologic diagnosis necessary to define benign lesion in 59-year-old man. CT (A), PET (B), and fused PET/CT (C) images show abnormal uptake of 18F-FDG in polypoid lesion (arrows) along right wall of rectum. Resected specimen (not shown) revealed tubulovillous adenoma with no evidence of malignancy.

View larger version (59K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —Composite figure of three patients with benign lung lesions on 18F-FDG PET/CT. CT image obtained using lung window setting (A), PET image (B), and zoomed CT image obtained using soft-tissue window setting (C) show marked uptake of FDG (arrows) in subpleural mass in left lower lobe of lung in 77-year-old woman. Zoomed CT image shows fat attenuation in center of mass, which is suggestive of lipoid pneumonia.

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —Composite figure of three patients with benign lung lesions on 18F-FDG PET/CT. CT image obtained using lung window setting (A), PET image (B), and zoomed CT image obtained using soft-tissue window setting (C) show marked uptake of FDG (arrows) in subpleural mass in left lower lobe of lung in 77-year-old woman. Zoomed CT image shows fat attenuation in center of mass, which is suggestive of lipoid pneumonia.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —Composite figure of three patients with benign lung lesions on 18F-FDG PET/CT. CT image obtained using lung window setting (A), PET image (B), and zoomed CT image obtained using soft-tissue window setting (C) show marked uptake of FDG (arrows) in subpleural mass in left lower lobe of lung in 77-year-old woman. Zoomed CT image shows fat attenuation in center of mass, which is suggestive of lipoid pneumonia.

View larger version (79K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —Composite figure of three patients with benign lung lesions on 18F-FDG PET/CT. CT (D), PET (E), and fused PET/CT (F) images. CT image shows multiple cysts (thin arrow, D) and nodules (thick arrow, D) in both lung fields in 61-year-old man. PET and fused PET/CT images show abnormal uptake of FDG in nodule (arrows, E and F). Findings are suggestive of Langerhans cell histiocytosis, which was confirmed on biopsy.

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6E —Composite figure of three patients with benign lung lesions on 18F-FDG PET/CT. CT (D), PET (E), and fused PET/CT (F) images. CT image shows multiple cysts (thin arrow, D) and nodules (thick arrow, D) in both lung fields in 61-year-old man. PET and fused PET/CT images show abnormal uptake of FDG in nodule (arrows, E and F). Findings are suggestive of Langerhans cell histiocytosis, which was confirmed on biopsy.

View larger version (55K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6F —Composite figure of three patients with benign lung lesions on 18F-FDG PET/CT. CT (D), PET (E), and fused PET/CT (F) images. CT image shows multiple cysts (thin arrow, D) and nodules (thick arrow, D) in both lung fields in 61-year-old man. PET and fused PET/CT images show abnormal uptake of FDG in nodule (arrows, E and F). Findings are suggestive of Langerhans cell histiocytosis, which was confirmed on biopsy.

View larger version (79K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6G —Composite figure of three patients with benign lung lesions on 18F-FDG PET/CT. CT (G), PET (H), and fused PET/CT (I) images show marked masslike abnormal uptake of FDG (arrows) on PET image in 53-year-old man. CT shows lung infiltrate thought to represent pneumonia. Infiltrate resolved on CT performed after antibiotic therapy (not shown).

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6H —Composite figure of three patients with benign lung lesions on 18F-FDG PET/CT. CT (G), PET (H), and fused PET/CT (I) images show marked masslike abnormal uptake of FDG (arrows) on PET image in 53-year-old man. CT shows lung infiltrate thought to represent pneumonia. Infiltrate resolved on CT performed after antibiotic therapy (not shown).

View larger version (58K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6I —Composite figure of three patients with benign lung lesions on 18F-FDG PET/CT. CT (G), PET (H), and fused PET/CT (I) images show marked masslike abnormal uptake of FDG (arrows) on PET image in 53-year-old man. CT shows lung infiltrate thought to represent pneumonia. Infiltrate resolved on CT performed after antibiotic therapy (not shown).

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