Authors: Ehab M Kamel Thomas A Mckee MariaLucia Calcagni Sabine Schmidt Serge Markl Sandra Castaldo Angelika Bischof Delaloye
Publish Date: 2005/02/22
Volume: 32, Issue: 6, Pages: 641-646
Abstract
The aim of the present report is to describe abnormal 18Ffluorodeoxyglucose 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 PETBetween November 2002 and December 2003 a total of 145 patients 102 males 43 females age range 38–85 years were subjected to wholebody 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 diagnosisOf 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 poststenotic 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 14–86 mean 39 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 preexisting diagnostic workup 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 embolismIn 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 interpretationThe 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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