Positron emission tomography (PET) with 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) has been shown to be sensitive in the detection of many bowel malignancies, but its specificity is lower because of various physiologic and pathologic patterns of bowel FDG uptake. PET-computed tomography (CT) can be useful in localizing and characterizing foci of increased FDG uptake within the bowel. As the use of PET-CT in the staging and monitoring of oncologic disease continues to expand, familiarity with these patterns of bowel FDG uptake is essential and can help determine the need for and the relative urgency of further testing. Although a variety of imaging protocols are used for PET-CT, the use of negative oral contrast agent allows improved bowel distention while eliminating potential artifacts caused by high-density oral contrast agents. In addition, correlation with the CT portion of the combined PET-CT examination can sometimes help identify the cause of focal or segmental bowel uptake. The radiologist should be aware of potential pitfalls in the evaluation of FDG-avid foci within the abdomen, including bowel motility and low-attenuation lesions mimicking bowel. Nevertheless, even though the precise role of combined PET-CT for bowel assessment has yet to be determined, the application of sound basic principles of image interpretation will help ensure the accurate interpretation of bowel findings seen with this combined modality.
The imaging features of sarcoidosis are diverse and can be seen on a variety of imaging techniques. It is important for radiologists and nuclear medicine physicians to recognize the common imaging features and patterns of sarcoidosis in order to raise the possibility in the appropriate clinical setting.
Imaging plays a central role in the diagnosis of adnexal masses, from the initial detection to characterization. Although ultrasound is often the first-line imaging modality in patients with adnexal masses, magnetic resonance imaging, computed tomography, and sometimes positron emission tomography-computed tomography are used for further evaluation. This chapter discusses the role of different imaging modalities in the evaluation of adnexal lesions as well as provides a summary of key imaging findings of common adnexal lesions.
FDG PET-CT plays an important role in treatment planning and in prognosis assessment of gynecologic cancer patients. Detection of hypermetabolic tissue with FDG PET, when combined with the high spatial resolution of CT, results in improved cancer detection and localization not afforded by either modality independently. This article is a primer for a radiologist performing PET-CT on gynecologic cancer patients and includes the imaging protocol, normal pattern of FDG distribution in the female pelvis and the lymph node drainage pathways from the gynecologic organs. Clinically relevant imaging findings that should be included in the report are discussed. Case examples illustrate how potential errors in exam interpretation can be avoided by concurrently performing a high-quality diagnostic CT with the FDG PET scan and by analyzing both the stand-alone and the fusion images.
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