Gastric activity can be seen and has a characteristic J-shape within the left upper abdomen. The uptake can be faint or it can be intense Fig. Although less common, esophageal activity canbe seen as a mild linear uptake anterior to the spine, mostly due to swallowed saliva and partially due to smooth muscle metabolism.
Prominent esophageal uptake is abnormal Figs. The colonic activity is also variable, ranging from faint heterogeneous activity, to mild focal, segmental, or diffuse activity Fig. Uptake in the cecum and right colon is usually higher than the rest of the colon because of the abundance of the lymphocyte cells, which are very glucose avid Fig. However, focal intense activity in the colon should be further evaluated with colonoscopy to exclude a neoplastic process.
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In some patients, the colonic uptake can cause a great clinical challenge, especially in the lower rectal region. By reviewing the sagittal and the rotating images, one can, in most cases, eliminate any pathologic uptake. The liver uptake is mostly faint and homogeneous. An overlapping loop of bowel can occasionally resemble a focal liver lesion; reviewing the corresponding CT slice can easily differentiate between the 2 conditions.
Stomach uptake. A Normal uptake: mild diffuse uptake arrows conforming to stomach configuration. B Adenocarcinoma of stomach: focal uptake in region of stomach. Coronal view on left; sagittal view on right. C Stomach lymphoma: intense focal uptake arrows. Dilated esophagus. A y-old man with known esophageal carcinoma. Note dilated esophagus with linear increased uptake on both sides. Chronic dilation is due to distal obstruction by tumor mass. Linear uptake is due to reactive inflammation.
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Esophageal uptake. Esophageal uptake in patient with gastroesophageal reflux disease. Colonic activity projection view.
Patient had bladder cancer, status post cystostomy, and ileal conduit. PET was done to rule out pelvic recurrence. Note nonspecific diffuse colonic activity a , ileal conduit b , urinary bag c , and area of recurrence d. Cecal uptake. A and B Normal diffuse physiologic uptake arrow in cecum. Because FDG is filtered through the glomeruli, without reabsorption unlike glucose, one should see the activity within the collecting system, ureters, and urinary bladder.
Hydration and frequent voiding promote diuresis and help to decrease the radiation dose to the genitourinary tract. Congenital urinary malformation and acquired structural deformity as in postsurgical intervention can create artifacts Figs. Dilated urinary bladder.
Note prominent right Rt kidney collecting system, right ureter, and dilated urinary bladder. Horseshoe kidney. B 99m Tc-Glucoheptonate scan confirms presence of horseshoe kidney. Renal activity. A Intense activity in right kidney collecting system overlapping right lobe of liver, simulating a liver lesion. B 99m Tc-Dimercaptosuccinic acid image of same patient confirms that right kidney is slightly higher than left. Bladder diverticulum.
A Bladder diverticulum caused by chronic bladder outlet obstruction by hypertrophied prostate. B Corresponding CT scan.
For example, a horseshoe kidney, congenital pelvic kidney, and transplanted kidney can simulate neoplastic lesions. Furthermore, focal urinary activity within the ureter can also simulate focal nodal neoplasia. One must also be aware of urine contamination and surgical tubes draining the kidney Fig. A Nephrostomy tube arrow.
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B Diaper artifact. Increased 18 F-FDG uptake has been reported in the normal uterus during menstruation 23 , 24 , in a follicular ovarian cyst 25 , and in the ovary with an inflammatory reaction during ovulation In a recent study by Nishizawa et al. On the other hand, all 9 women in the first 3 d of the menstrual cycle demonstrated intense 18 F-FDG uptake in the endometrium, with an SUV of 4.
The authors concluded that in women of reproductive age, 18 F-FDG imaging should preferably be done within a week before or a few days after the menstrual flow phase to avoid any misinterpretation of pelvic 18 F-FDG PET images Vigorous exercise in the days just before a scan can cause intense uptake in the associated skeletal muscles.
Skeletal muscle uptake could be enhanced not only because of exercise activity but also because of stress-induced muscle tension as is often seen in the trapezius and paraspinal muscles. Hyperventilation may induce uptake in the diaphragm as well. Muscle uptake is typically symmetric, mild-to-moderate linear activity Figs.
However, occasionally the uptake can be focal and unilateral, which could create a diagnostic challenge, especially in head and neck cancer and lymphoma.
Variants and Pitfalls in Body Imaging (Thoracic, Abdominal and Women's Imaging)
Similarly, the use of insulin to adjust the serum glucose level immediately before injection of 18 F-FDG can result in 18 F-FDG accumulation in skeletal muscle. Benzodiazepines may be used to decrease paraspinal and posterior cervical muscle uptake in tense patients. Muscle uptake. Symmetric muscle uptake in neck arrows. Intercostal muscle uptake due to persistent coughing projection view.
In addition to the muscles, increased 18 F-FDG uptake can be seen in the adipose tissue of the neck, supraclavicular regions, around the large vessels in the mediastinum, the axillae, the perinephric regions, and in the intercostal spaces along the thoracic spine in 3. Uptake in the neck adipose tissue is typically bilateral and symmetric, intense, and more often multifocal than linear 29 Fig.
Brown fat uptake. A Asymmetric neck uptake arrows. B Intense symmetric uptake in adipose tissue arrows. Brown fat can cause difficulty in scan interpretation. Thymus uptake is a normal finding in children and young adults, appearing as an upside down letter V. Also, thymus hyperplasia after chemotherapy is a normal variant in the adult population as well 25 , 30 Fig. Thymus uptake coronal views. A Diffuse thymus uptake arrow. B Focal thymus uptake arrow. Bone marrow accumulation of 18 F-FDG is generally faint diffuse low-grade activity, less than liver activity and mostly seen in vertebral bodies.
Focal activity within bone marrow is always suspicious for an abnormality. Uniform diffuse increased bone marrow activity can be seen also with bone marrow recovery after chemotherapy, which usually resolves by 1 mo after therapy In a study by Yao et al.
http://vipauto93.ru/profiles/come/rintracciare-la-posizione-di-un-numero-di-cellulare.php Sugawara et al. The identification of bone metastases could be a challenging task in this group of patients. Therefore, depending on the clinical situation, waiting for 2—4 wk before performing the 18 F-FDG study is advised. Bone marrow. Intense 18 F-FDG uptake in bone marrow is attributed to hematopoietic growth factor. Normally, there is faint uptake of 18 F FDG in the spleen.
Because the spleen is an active site for the extramedullary hematopoiesis, one would expect to see a diffuse enhanced 18 F-FDG uptake in conjunction with diffuse bone marrow uptake after administration of HGF, such as G-CSF and erythropoietin Fig. Similarly; other hematologic diseases such as thalassemia, which can cause extramedullary hematopoiesis, can also lead to enhanced 18 F-FDG uptake in the spleen Furthermore, other nonneoplastic conditions such as infection can cause diffuse enhancement of glucose uptake within the spleen.
In addition, the 18 F-FDG uptake can be enhanced by inflammatory induced changes, which include postoperative healing scars and postradiation therapy Figs. A unique example of an inflammatory condition is the one caused by the atherosclerotic plaque formation that is associated with an abundance of macrophages known by its avidity to 18 F-FDG 45 — 47 Fig. The degree of uptake is usually less than the uptake within the neoplastic tissues. However, there is clearly an overlap between the 2 conditions and, in some cases, the uptake could even exceed the neoplastic uptake.
Furthermore; the image interpreter should be aware of a high accumulation of 18 F-FDG in some benign tumors, such as giant cell tumor, fibrous dysplasia of the bone, and adenomatous polyps in the colon 48 , Fungal infection in liver of pediatric patient. A Before therapy arrow. B Infection resolved on image after specific antifungal therapy. Scar tissue from recent surgery. Patient underwent recent abdominal surgery for hernia repair. Note linear superficial increased 18 F-FDG uptake along anterior abdominal wall conforming to abdominal scar tissue arrow.
Abdominal fibrosis, honeycomb appearance.