Imaging patterns of liver uptakes on PET scan: pearls and pitfalls

Luk, Wing Hang; Au-Yeung, Andrea Wai San; Loke, Tkl

doi:10.5603/nmr.2013.0039

Cited by 13 publications

(6 citation statements)

References 37 publications

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“…Yet, 18 FDG is well known to accumulate in inflammatory cells such as lymphocytes, neutrophils and macrophages in various inflammatory conditions due to elevated glucose requirements. The increased uptake of FDG in such lesions mimics the imaging characteristics of malignant tissue leading to false positive results [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Granuloma Mimicking Local Recurrence on PET/CT after Liver Resection of Colorectal Liver Metastasis: A Case Report

Pantiora

Kontis

Michalaki

et al. 2016

Cureus

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Positron emission tomography–computed tomography (PET/CT) improves the diagnostic interpretation of fluorine-18 fluorodeoxyglucose (18F-FDG ) PET and CT in oncologic patients and has an impact on both diagnostic and therapeutic aspects of patient management. However, false positive findings from the PET/CT imaging should be taken into consideration as they mislead physicians into improper therapeutic actions. We present a 48-year-old female patient with a history of left colectomy for colorectal cancer and subsequent liver metastasectomy. After one year of follow-up, she presented with a highly suspicious lesion in the liver, which was confirmed on PET/CT as a metastatic liver tumor. Consequently, the patient underwent surgical excision of the tumor, and the definitive histological diagnosis showed a granulomatous tissue with giant cells and foreign body tissue reaction. Based on this report, we briefly review the dangerous pitfalls from radiological and PET/CT imaging concerning the preoperative diagnostic workup examination, as they may significantly alter the treatment plan in oncologic patients.

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Section: Discussionmentioning

confidence: 99%

Granuloma Mimicking Local Recurrence on PET/CT after Liver Resection of Colorectal Liver Metastasis: A Case Report

Pantiora

Kontis

Michalaki

et al. 2016

Cureus

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“…"Hepatic superscan" is an uncommon PET-CT finding. The term is applied when intense hepatic FDG uptake is seen in combination with low cardiac, bowel, renal and brain FDG uptake, similar to skeletal scintigraphy [4]. This finding may be seen in extensive hepatic involvement by malignancy such as metastatic disease, lymphoma or hepatocellular carcinoma [5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“Hepatic Superscan” on a PET- CT scan of a patient with metastatic breast carcinoma

Hk¹,

Bw²,

Ridge³

2017

Nucl Med Biomed Imaging

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“…The mechanism behind FDG accumulation in RILI remains uncertain, but it likely involves an inflammatory component. It is well-documented that radiation-induced inflammation, such as postradiotherapy esophagitis [ 36 ], shows high FDG uptake due to leukocyte glucose metabolism [ 5 , 47 ]. The exact timing and duration of this phenomenon are unclear.…”

Section: Rild Inducing False Fdg Pet-ct Interpretationsmentioning

confidence: 99%

False Liver Metastasis by Positron Emission Tomography/Computed Tomography Scan after Chemoradiotherapy for Esophageal Cancer—Potential Overstaged Pitfalls of Treatment

Shai,

Lai,

Chang

et al. 2024

Cancers

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In patients with esophageal cancer undergoing neoadjuvant chemoradiotherapy (nCRT), subsequent restaging with F-18-fluorodeoxyglucose (18F-FDG) positron emission tomography–computed tomography (PET-CT) can reveal the presence of interval metastases, such as liver metastases, in approximately 10% of cases. Nevertheless, it is not uncommon in clinical practice to observe focal FDG uptake in the liver that is not associated with liver metastases but rather with radiation-induced liver injury (RILI), which can result in the overstaging of the disease. Liver radiation damage is also a concern during distal esophageal cancer radiotherapy due to its proximity to the left liver lobe, typically included in the radiation field. Post-CRT, if FDG activity appears in the left or caudate liver lobes, a thorough investigation is needed to confirm or rule out distant metastases. The increased FDG uptake in liver lobes post-CRT often presents a diagnostic dilemma. Distinguishing between radiation-induced liver disease and metastasis is vital for appropriate patient management, necessitating a combination of imaging techniques and an understanding of the factors influencing the radiation response. Diagnosis involves identifying new foci of hepatic FDG avidity on PET/CT scans. Geographic regions of hypoattenuation on CT and well-demarcated regions with specific enhancement patterns on contrast-enhanced CT scans and MRI are characteristic of radiation-induced liver disease (RILD). Lack of mass effect on all three modalities (CT, MRI, PET) indicates RILD. Resolution of abnormalities on subsequent examinations also helps in diagnosing RILD. Moreover, it can also help to rule out occult metastases, thereby excluding those patients from further surgery who will not benefit from esophagectomy with curative intent.

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Imaging patterns of liver uptakes on PET scan: pearls and pitfalls

Abstract: Knowing the pitfalls of PET imaging, correlation with clinical background and findings from other imaging modalities are all important in the correct interpretation of increased hepatic activity on PET imaging.

Cited by 13 publications

References 37 publications

Granuloma Mimicking Local Recurrence on PET/CT after Liver Resection of Colorectal Liver Metastasis: A Case Report

Granuloma Mimicking Local Recurrence on PET/CT after Liver Resection of Colorectal Liver Metastasis: A Case Report

“Hepatic Superscan” on a PET- CT scan of a patient with metastatic breast carcinoma

False Liver Metastasis by Positron Emission Tomography/Computed Tomography Scan after Chemoradiotherapy for Esophageal Cancer—Potential Overstaged Pitfalls of Treatment

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