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PET/CT Detection of Unexpected Gastrointestinal Foci of ¹⁸F-FDG Uptake: Incidence, Localization Patterns, and Clinical Significance

¹ Department of Nuclear Medicine, Rambam Medical Center, Haifa, Israel
² B. Rappaport School of Medicine, Technion, Israel
³ Department of Diagnostic Radiology, Rambam Medical Center, Haifa, Israel

View larger version (76K): [in a new window]   FIGURE 1. Focal 18F-FDG uptake in 57-y-old woman who had undergone total gastrectomy for stomach cancer and was being evaluated for fatigue, abdominal pain, frequent vomiting, equivocal endoscopic findings at level of anastomosis, and negative findings on whole-body CT. (A) From left to right, coronal, sagittal, and transaxial PET slices show focus of increased 18F-FDG uptake (arrows) in left lower abdomen. (B) Area of increased uptake (arrows) was localized by PET/CT (left panel) to small bowel, as seen on corresponding CT image (right panel). PET/CT-guided surgery revealed small-bowel metastasis originating from primary gastric cancer. No abnormal 18F-FDG uptake was seen in region of anastomosis, and there was no further evidence of disease in this area.

View larger version (85K): [in a new window]   FIGURE 2. Focal 18F-FDG uptake in 64-y-old woman who was being evaluated for staging of aggressive non-Hodgkin’s lymphoma. (A) From left to right, coronal, sagittal, and transaxial PET slices show focus of increased 18F-FDG uptake (arrows) in left pelvis. Coronal and sagittal PET images show additional areas of abnormal 18F-FDG uptake in mediastinum and left upper abdomen (open arrows), consistent with sites of active lymphoma. (B) Pelvic area of increased uptake (arrows) was localized by PET/CT (left panel) to sigmoid, as seen on corresponding CT image (right panel). Villous adenoma was diagnosed from biopsy sample taken during colonoscopy.

View larger version (79K): [in a new window]   FIGURE 3. Focal 18F-FDG uptake in 70-y-old woman with low-grade non-Hodgkin’s lymphoma who was undergoing routine follow-up examination. (A) Coronal, sagittal, and transaxial PET slices show focus of increased 18F-FDG uptake (arrows) in right upper abdomen. (B) Area of increased uptake (arrows) was localized by PET/CT (left panel) to ascending colon, as seen on corresponding CT image (right panel). Colonoscopy had negative findings, and patient showed no evidence of disease after 16 mo of follow-up. Focus of increased 18F-FDG uptake was considered to represent physiologic bowel activity.