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Occult lung infarction may induce false interpretation of 18F-FDG PET in primary staging of pulmonary malignancies

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The aim of the present report is to describe abnormal 18F-fluorodeoxyglucose (FDG) accumulation patterns in the pleura and lung parenchyma in a group of lung cancer patients in whom lung infarction was present at the time of positron emission tomography (PET).

Methods

Between November 2002 and December 2003, a total of 145 patients (102 males, 43 females; age range 38–85 years) were subjected to whole-body FDG PET for initial staging (n=117) or restaging (n=11) of lung cancer or for evaluation of solitary pulmonary nodules (n=17). Of these patients, 24 displayed abnormal FDG accumulation in the lung parenchyma that was not consistent with the primary lesion under investigation (ipsilateral n=12, contralateral n=9 or bilateral n=3). Without correlative imaging, this additional FDG uptake would have been considered indeterminate in differential diagnosis.

Results

Of the 24 patients who were identified as having such lesions, six harboured secondary tumour nodules diagnosed as metastases, while in three the diagnosis of a synchronous second primary lung tumour was established. Additionally, nine patients were identified as having post-stenotic pneumonia and/or atelectasis (n=6) or granulomatous lung disease (n=3). In the remaining six (4% of all patients), a diagnosis of recent pulmonary embolism that topographically matched the additional FDG accumulation (SUVmax range 1.4–8.6, mean 3.9) was made. Four of these six patients were known to have pulmonary embolism, and hence false positive interpretation was avoided by correlating the PET findings with those of the pre-existing diagnostic work-up. The remaining two patients were harbouring small occult infarctions that mimicked satellite nodules in the lung periphery. Based on histopathological results, the abnormal FDG accumulation in these two patients was attributed to the inflammatory reaction and tissue repair associated with the pathological cascade of pulmonary embolism.

Conclusion

In patients with pulmonary malignancies, synchronous lung infarction may induce pathological FDG accumulation that can mimic active tumour manifestations. Identifying this potential pitfall may allow avoidance of false positive FDG PET interpretation.

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Acknowledgements

The authors gratefully acknowledge the technical assistance provided by Chantal Séverin, Murielle Croisier and Jérôme Malterre. Part of this work was presented at the 51st Annual Meeting of the Society of Nuclear Medicine, Philadelphia, PA, June 19–23, 2004.

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Authors and Affiliations

  1. Division of Nuclear Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), CH-1011, Lausanne, Switzerland

    Ehab M. Kamel, Maria-Lucia Calcagni, Serge Markl, Sandra Castaldo & Angelika Bischof Delaloye

  2. University Institute of Pathology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

    Thomas A. Mckee

  3. Division of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

    Sabine Schmidt

Authors
  1. Ehab M. Kamel
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  2. Thomas A. Mckee
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  3. Maria-Lucia Calcagni
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  4. Sabine Schmidt
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  5. Serge Markl
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  6. Sandra Castaldo
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  7. Angelika Bischof Delaloye
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Correspondence to Ehab M. Kamel.

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Kamel, E.M., Mckee, T.A., Calcagni, ML. et al. Occult lung infarction may induce false interpretation of 18F-FDG PET in primary staging of pulmonary malignancies. Eur J Nucl Med Mol Imaging 32, 641–646 (2005). https://doi.org/10.1007/s00259-004-1718-3

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  • DOI: https://doi.org/10.1007/s00259-004-1718-3

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