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Review
. 2022 Mar 21:2:847810.
doi: 10.3389/fnume.2022.847810. eCollection 2022.

18F-FDG PET/CT Imaging: Normal Variants, Pitfalls, and Artifacts Musculoskeletal, Infection, and Inflammation

Olwethu Mbakaza  1 , Mboyo-Di-Tamba Willy Vangu  1
Affiliations
Review

18F-FDG PET/CT Imaging: Normal Variants, Pitfalls, and Artifacts Musculoskeletal, Infection, and Inflammation

Olwethu Mbakaza et al. Front Nucl Med. .

Abstract

18F-FDG PET/CT is an integral part of modern-day practice, especially in the management of individuals presenting with malignant processes. The use of this novel imaging modality in oncology has been rapidly evolving. However, due to its detection of cellular metabolism, it is not truly tumor specific. 18F-FDG is also used in the detection of infective and inflammatory disorders. One of the challenges experienced with 18F-FDG PET/CT imaging is the correct differentiation of abnormal uptake that is potentially pathologic, from physiological uptake. Imaging readers, particularly the nuclear physicians, therefore need to be aware of normal physiological variants of uptake, as well as potential pitfalls and artifacts when imaging with 18F-FDG. This is true for musculoskeletal uptake, where more than often, infective and inflammatory processes should not be mistaken for malignancy. This article aims to provide a pictorial review and analysis of cases that depict musculoskeletal, infective, and inflammatory uptake as normal variants, pitfalls, and artifacts on 18F-FDG PET/CT imaging. The impact of this article is to help in the minimizing of poor imaging quality, erroneous interpretations and diminishes misdiagnoses that may impact on the adequate management of patients with undesirable consequences.

Keywords: 18F-FDG PET/CT; artifacts; infection; inflammation; musculoskeletal; normal variants; pitfalls.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Combined PET/CT and CT images of a 54-year-old man with esophageal melanoma. He has multiple sites of skeletal uptake attributable to recent trauma: in the R lateral 8th and 9th ribs (A,B), superior pubic ramus (C,D), and inferior pubic ramus (E,F).
Figure 2
Figure 2
A 42-year-old woman with Hodgkin's lymphoma. 18F-FDG PET maximum intensity projection (MIP) (A) and transaxial (B) images showed focal intense uptake in the right buttock. Fine-needle aspiration cytology showed nodular fasciitis.
Figure 3
Figure 3
A 70-year-old woman with adenocarcinoma of the colon. 18F-FDG PET/CT (A) and CT (B) images show increased FDG uptake in an opacified nasal passage, which reflects inflammation rather than metastases.
Figure 4
Figure 4
Young woman with Hodgkin's disease and underlying retroviral disease. CT (A), PET (B), combined PET/CT (C), and MIP (D) images show focal increased uptake in the right buttock, most likely inflammatory.
Figure 5
Figure 5
18F-FDG PET (A), CT (B), and combined PET/CT (C) images of a 38-year-old woman with retroviral disease and stage III Ca cervix. She has a metabolically active collection in the left psoas muscle—with radiological features of a cold abscess which, in this case, is secondary to TB. The left psoas collection extends into the vertebral column with resultant compression fracture of the vertebral body of L4.
Figure 6
Figure 6
A 54-year-old man with renal cell carcinoma. Combined PET/CT images showed an intense lesion in the left side of the mandible, which was due to osteomyelitis.
Figure 7
Figure 7
Combined PET/CT images of a 67-year-old woman with anal carcinoma. There is diffuse uptake in the skeletal muscles of the neck (A), chest (B), and upper limbs (C)—related to muscular exertion.
Figure 8
Figure 8
A 69-year-old woman with left breast carcinoma. Combined PET/CT (A) and PET maximum intensity projection (MIP) (C) images show intense uptake in the gleno-humeral joints, with subchondral cystic osteodegenerative changes on CT (B).
Figure 9
Figure 9
(A) A 68-year-old woman with basal cell carcinoma of the left breast. Combined PET/CT images show intense uptake in the right facet joint of L3/L4, which is consistent with osteodegenerative change. (Ba-c) Same patient as in (A) above with increased uptake in the spinous process.
Figure 10
Figure 10
56 year old woman with ovarian Ca. Combined PET/CT and PET images show intense uptake in the left acromio-clavicular joint, which is osteodegenerative.
Figure 11
Figure 11
50 year old man with melanoma of the scalp. PET and Combined PET/CT images show intense uptake in the left sternoclavicular joint, which is osteodegenerative.
Figure 12
Figure 12
59 year old woman with breast Ca. Combined PET/CT and PET images show intense uptake in the left facet joint of L5/S1, which is osteodegenerative.
Figure 13
Figure 13
A 56-year-old man with sinonasal carcinoma of the hard palate. Combined PET/CT (A) and CT (B) images show intense uptake related to a metallic artifact in the left anterior thigh.
See this image and copyright information in PMC

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