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False-Positive Findings on 18F-FDG PET/CT: Differentiation of Hibernoma and Malignant Fatty Tumor on the Basis of Fluctuating Standardized Uptake Values

¹ Department of Radiology and Nuclear Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10021.
² Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —82-year-old woman with newly diagnosed lymphoma. Coronal (A) and axial (B) PET, axial CT (C), and fusion axial PET/CT (D) images from staging 18F-FDG PET/CT show hypermetabolic enlarged spleen and right retroperitoneal adenopathy (white arrows, B–D) and small focus of increased activity in left paraspinal region (black arrow).

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —82-year-old woman with newly diagnosed lymphoma. Coronal (A) and axial (B) PET, axial CT (C), and fusion axial PET/CT (D) images from staging 18F-FDG PET/CT show hypermetabolic enlarged spleen and right retroperitoneal adenopathy (white arrows, B–D) and small focus of increased activity in left paraspinal region (black arrow).

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —82-year-old woman with newly diagnosed lymphoma. Coronal (A) and axial (B) PET, axial CT (C), and fusion axial PET/CT (D) images from staging 18F-FDG PET/CT show hypermetabolic enlarged spleen and right retroperitoneal adenopathy (white arrows, B–D) and small focus of increased activity in left paraspinal region (black arrow).

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —82-year-old woman with newly diagnosed lymphoma. Coronal (A) and axial (B) PET, axial CT (C), and fusion axial PET/CT (D) images from staging 18F-FDG PET/CT show hypermetabolic enlarged spleen and right retroperitoneal adenopathy (white arrows, B–D) and small focus of increased activity in left paraspinal region (black arrow).

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —82-year-old woman with newly diagnosed lymphoma. Coronal (E) and axial (F) PET, axial CT (G), and fusion axial PET/CT (H) images from FDG PET/CT performed after four cycles of rituximab, vincristine, doxorubicin, cyclophosphamide, and prednisone (R-CHOP) therapy show resolution of activity in spleen and retroperitoneum and increase in activity in left paraspinal region (arrow). Biopsy result was hibernoma.

View larger version (89K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1F —82-year-old woman with newly diagnosed lymphoma. Coronal (E) and axial (F) PET, axial CT (G), and fusion axial PET/CT (H) images from FDG PET/CT performed after four cycles of rituximab, vincristine, doxorubicin, cyclophosphamide, and prednisone (R-CHOP) therapy show resolution of activity in spleen and retroperitoneum and increase in activity in left paraspinal region (arrow). Biopsy result was hibernoma.

View larger version (82K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1G —82-year-old woman with newly diagnosed lymphoma. Coronal (E) and axial (F) PET, axial CT (G), and fusion axial PET/CT (H) images from FDG PET/CT performed after four cycles of rituximab, vincristine, doxorubicin, cyclophosphamide, and prednisone (R-CHOP) therapy show resolution of activity in spleen and retroperitoneum and increase in activity in left paraspinal region (arrow). Biopsy result was hibernoma.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1H —82-year-old woman with newly diagnosed lymphoma. Coronal (E) and axial (F) PET, axial CT (G), and fusion axial PET/CT (H) images from FDG PET/CT performed after four cycles of rituximab, vincristine, doxorubicin, cyclophosphamide, and prednisone (R-CHOP) therapy show resolution of activity in spleen and retroperitoneum and increase in activity in left paraspinal region (arrow). Biopsy result was hibernoma.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1I —82-year-old woman with newly diagnosed lymphoma. Photomicrograph of biopsy specimen from left paraspinal mass shows benign adipose cells of brown fat type. Cells have distinct cell borders with multiple vacuoles in cytoplasm or eosinophilic granular cytoplasm with areas composed of mature adipose tissue. (H and E, x40)

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —54-year-old man with increasing level of prostate-specific antigen after radical prostatectomy. Coronal PET images from serial 18F-FDG PET/CT show focus of increased activity in fatty-appearing lesion adjacent to left teres major muscle (arrow, B and C). Standard uptake value fluctuates over time from no uptake (A) through 6.7 approximately 1 month later (B) to 5.0 3 months after that (C).

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —54-year-old man with increasing level of prostate-specific antigen after radical prostatectomy. Coronal PET images from serial 18F-FDG PET/CT show focus of increased activity in fatty-appearing lesion adjacent to left teres major muscle (arrow, B and C). Standard uptake value fluctuates over time from no uptake (A) through 6.7 approximately 1 month later (B) to 5.0 3 months after that (C).

View larger version (82K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —54-year-old man with increasing level of prostate-specific antigen after radical prostatectomy. Coronal PET images from serial 18F-FDG PET/CT show focus of increased activity in fatty-appearing lesion adjacent to left teres major muscle (arrow, B and C). Standard uptake value fluctuates over time from no uptake (A) through 6.7 approximately 1 month later (B) to 5.0 3 months after that (C).

View larger version (62K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —54-year-old man with increasing level of prostate-specific antigen after radical prostatectomy. Axial contrast-enhanced CT scan obtained 20 months after A–C shows stability in both size and appearance of fatty lesion adjacent to left teres major muscle (arrow).

View larger version (82K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —55-year-old man with newly diagnosed colorectal cancer. Coronal (A) and axial (B) PET, axial CT (C), and fusion axial PET/CT (D) images from 18F-FDG PET/CT show increased FDG activity within numerous hepatic metastatic lesions (white arrow). Focus of increased activity deep in relation to left latissimus dorsi muscle within fatty-appearing lesion (black arrow) suggests hibernoma.

View larger version (76K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —55-year-old man with newly diagnosed colorectal cancer. Coronal (A) and axial (B) PET, axial CT (C), and fusion axial PET/CT (D) images from 18F-FDG PET/CT show increased FDG activity within numerous hepatic metastatic lesions (white arrow). Focus of increased activity deep in relation to left latissimus dorsi muscle within fatty-appearing lesion (black arrow) suggests hibernoma.

View larger version (106K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —55-year-old man with newly diagnosed colorectal cancer. Coronal (A) and axial (B) PET, axial CT (C), and fusion axial PET/CT (D) images from 18F-FDG PET/CT show increased FDG activity within numerous hepatic metastatic lesions (white arrow). Focus of increased activity deep in relation to left latissimus dorsi muscle within fatty-appearing lesion (black arrow) suggests hibernoma.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —55-year-old man with newly diagnosed colorectal cancer. Coronal (A) and axial (B) PET, axial CT (C), and fusion axial PET/CT (D) images from 18F-FDG PET/CT show increased FDG activity within numerous hepatic metastatic lesions (white arrow). Focus of increased activity deep in relation to left latissimus dorsi muscle within fatty-appearing lesion (black arrow) suggests hibernoma.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —55-year-old man with newly diagnosed colorectal cancer. Axial contrast-enhanced CT scan obtained 12 months after chemotherapy shows decrease in size of hepatic metastatic lesions and decrease in size of fatty lesion deep in relation to left latissimus dorsi muscle.

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