Incidental head and neck 18F-FDG uptake on PET/CT without corresponding morphological lesion: early predictor of cancer development?

Heusner, Till A.; Hahn, Steffen; Hamami, M; Kögel, Svenja; Forsting, Michael; Bockisch, Andreas; Antoch, Gerald; Stahl, Alexander

doi:10.1007/s00259-009-1113-1

Cited by 32 publications

(16 citation statements)

References 44 publications

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“…However, all the ultrasound scans were performed by 2 experienced consultant radiologists with an interest in thyroid disease who did not find a distinct focal suspicious abnormality worthy of biopsy in the remaining 17 cases. In contrast to other studies, Heusner et al [14] detected FDG uptake in the thyroid gland in 31% of patients, mostly symmetric, but there was not a single Incidental findings on PET/CT scans case of confirmed thyroid malignancy. This study concluded that, for populations in which thyroid goitre is endemic, FDG uptake by the thyroid is common and not associated with thyroid cancer.…”

Section: Incidental Findings On Pet/ct Scanscontrasting

confidence: 43%

“…Heusner et al [14] examined the intensity and symmetry of FDG uptake at 4 sites (Waldeyer's ring, oral floor, larynx and thyroid) in 590 patients without a head or neck malignancy, inflammation or a correlating morphological lesion on a fully diagnostic CT scan to determine whether the increased FDG uptake indicated the development of a head and neck malignancy. Increased FDG uptake was present in one of the sites of interest in 60% of cases.…”

Section: Incidental Findings On Pet/ct Scansmentioning

confidence: 99%

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Incidental findings on positron emission tomography/CT scans performed in the investigation of lung cancer

Chopra¹,

Ford²,

Noronha³

et al. 2012

BJR

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Objectives: This study aimed to clarify the number and cause of incidental findings detected on positron emission tomography (PET)/CT in patients undergoing investigation for presumed lung cancer. Methods: The scan reports from PET/CT studies performed for patients with lung cancer under National Institute for Clinical Evidence guidelines from January 2006 until March 2008 were retrospectively reviewed. Incidental findings were followed up by a combination of case note review, clinician feedback, colonoscopy database, histopathology and follow-up imaging. Results: 818 patients were investigated for lung cancer in the study period. 197 incidental findings were found in 175 (21%) patients. The subsequent investigation of 108 lesions confirmed a pathological correlation in 71 (66%) cases. A second primary malignancy was found in 10 patients within the bowel (6), breast (2), tongue (1) and stomach (1). A pre-malignant lesion was confirmed in 25 cases (24 large bowel tubulovillous adenomas and a follicular thyroid lesion). A further 41 (5%) benign abnormalities were detected at multiple sites; the thyroid gland was the single most frequently affected site (14 abnormalities). There were 36 (4.4%) false-positive reported findings, including 17 in the region of the pharynx and larynx and 12 within the large bowel. Conclusions: Overall, 9.2% of patients with suspected or known lung cancer having PET/CT had a confirmed incidental finding. A malignant or pre-malignant lesion was found in 1.2% and 3.0%, respectively. These were mostly located within the gastrointestinal tract. The majority of false-positive incidental findings were located in the larynx and pharynx. Uptake in these regions is unlikely to be significant in the absence of a CT morphological correlation.

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Section: Incidental Findings On Pet/ct Scanscontrasting

confidence: 43%

Section: Incidental Findings On Pet/ct Scansmentioning

confidence: 99%

Incidental findings on positron emission tomography/CT scans performed in the investigation of lung cancer

Chopra¹,

Ford²,

Noronha³

et al. 2012

BJR

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show abstract

“…A variation of 3.2 was considered clinically relevant using an average score of 10 with an SD of 3 in a referred population studied with a standard method (17). To obtain a strength of 90%, it would have been necessary to recruit 22 patients; the available number of patients in our study (34) was a sufficient number to perform the study.…”

Section: Discussionmentioning

confidence: 99%

Assessment of a New 18F-FDG PET/CT Protocol in the Staging of Oral Cavity Carcinomas

Cistaro¹,

Palandri²,

Balsamo³

et al. 2011

Journal of Nuclear Medicine Technology

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Because image fusion using 18 F-FDG PET/CT allows a better localization of the pathologic uptake, this modality has a greater sensitivity than PET alone in examining the head-neck region. However, examination of this area is particularly critical because the head and neck are close to other anatomic structures and because of the high physiologic uptake of the radiocompound. The purpose of this study was to evaluate the utility of a new imaging protocol in the staging of oral carcinoma. Methods: Thirty-four consecutive patients (21 women and 13 men; age range, 20-84 y) with untreated biopsy-proven oral squamous cell carcinomas were examined using whole-body 18 F-FDG PET/CT fusion imaging. All patients observed strict regulations before undergoing the PET/CT examination. At the end of the whole-body acquisition, another open-mouth scan was obtained. To compare the open-and closed-mouth methods, we analyzed features such as the feasibility of an accurate topographic localization of the tumor, evaluation of tumor extent, detection of tumor involvement with adjacent structures, and involvement of lymph nodes to which we assigned a score from 1 to 5. Results: No cases of 18 F-FDG physiologic uptake in the tongue or muscles were observed. The open-mouth scan obtained a better score than did the closed-mouth scan when considering the tumor localization, tumor extent, and evaluation of adjacent anatomic structures near the clinically evident tumor. For lymph node involvement, the 2 methods showed similar results. Conclusion:The open-mouth scan improved the anatomic tumor localization and extent and detection of tumor involvement in adjacent anatomic structures achieved by the standard PET/CT procedure. In addition, time of the examination (mid morning), relaxation of muscles before the compound was administered, and an upright position while the patient waited caused a reduction of the frequent equivocal physiologic uptake in the head and neck region. The open-mouth method does not influence the nodal staging.

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“…Although increased, unilateral glucose metabolism can be caused by inflammatory processes or asymmetrical focal muscular activity and has to be considered as nonspecific in most cases, it can mimic malignant processes (26,27). Heusner et al (27) demonstrated that unilateral or asymmetrical muscular uptake without a morphologic correlate is no predictor for malignancy. Still, its presence can be problematic in some cases, particularly if the quality of morphologic images is impaired by motion In the thyroid, focal tracer uptake is problematic.…”

Section: Discussionmentioning

confidence: 99%

Is integrated 18F-FDG PET/MRI superior to 18F-FDG PET/CT in the differentiation of incidental tracer uptake in the head and neck area?

Schaarschmidt

Gomez

Buchbender³

et al. 2017

Diagn Interv Radiol

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Incidental head and neck 18F-FDG uptake on PET/CT without corresponding morphological lesion: early predictor of cancer development?

Abstract: Elevated/asymmetric head and neck FDG accumulation without a correlating morphological lesion can frequently be found and does not predict cancer development. In populations in which goitre is endemic, FDG uptake by the thyroid is common and not associated with thyroid cancer.

Cited by 32 publications

References 44 publications

Incidental findings on positron emission tomography/CT scans performed in the investigation of lung cancer

Incidental findings on positron emission tomography/CT scans performed in the investigation of lung cancer

Assessment of a New 18F-FDG PET/CT Protocol in the Staging of Oral Cavity Carcinomas

Is integrated 18F-FDG PET/MRI superior to 18F-FDG PET/CT in the differentiation of incidental tracer uptake in the head and neck area?

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