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Focal Tracer Uptake: A Potential Artifact in Contrast-Enhanced Dual-Modality PET/CT Scans

Gerald Antoch, MD1, Lutz S. Freudenberg, MD2, Thomas Egelhof, MD1, Jörg Stattaus, MD1, Walter Jentzen, PhD2, Jörg F. Debatin, MD, MBA1 and Andreas Bockisch, MD, PhD2

1 Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
2 Department of Nuclear Medicine, University Hospital Essen, Essen, Germany



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  		FIGURE 1. Attenuation-corrected PET image (A), PET/CT fusion image (B), CT image (C), and PET image uncorrected for attenuation (D) of 43-y-old woman with centrally located non–small cell cancer of right lung and mediastinal lymph node metastasis. PET attenuation artifact is due to highly concentrated contrast agent in right subclavian vein (arrow in A), which is not detectable on PET image uncorrected for attenuation (D). On attenuation-corrected PET, hot spot in right axillary region could be misinterpreted as metastasis.

 


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  		FIGURE 2. Attenuation-corrected PET image (A), PET/CT fusion image (B), CT image (C), and PET image uncorrected for attenuation (D) of 34-y-old man with hepatic metastases from colorectal cancer. Artifact caused by contrast agent leads to error in CT-based attenuation correction of PET images and simulates focal tracer uptake. Without knowledge of fusion images, interpreter is likely to misinterpret finding as mediastinal lymph node metastasis. When PET images are uncorrected for attenuation, artifact is not expressed (D).

 


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  		FIGURE 3. Attenuation per unit density at different energies for soft tissue, bone, and iodine. Iodine contrast agents cause higher attenuation at CT energies than at PET photon energy.

 




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