European Journal of Nuclear Medicine

, Volume 23, Issue 10, pp 1409–1415 | Cite as

Fluorine-18 deoxyglucose and false-positive results: a major problem in the diagnostics of oncological patients

  • Ludwig G. Strauss
Review Article


Fluorine-18 deoxyglucose (FDG) is not a very tumour-specific substance, and its accumulation in benign lesions with increased glucose metabolism may give rise to false-positive results and hence cause FDG positron emission tomography (PET) to display relatively low specificity (frequently below 85%). Correct interpretation of FDG PET studies is predicated upon detailed knowledge of morphological abnormalities, and the importance of the correlation of functional and morphological information, as derived from computed tomography or magnetic resonance imaging, is discussed. It is emphasized that image fusion programs cannot substitute for understanding of functional and morphological methods. The reconstruction of PET cross-sections is considered, and it is concluded that an iterative image reconstruction method is to be favoured, given its advantages in reducing image artefacts and improving quantification of radioactivity concentrations. The differentiation of malignant and benign lesions when using FDG PET is then reviewed; false-positive findings may be obtained, for example, in patients with acute inflammatory lesions, chronic pancretitis, retroperitoneal fibrosis or salivary gland tumours. It is suggested that these problems may be alleviated by means of multitracer studies, e.g. using carbon-11 labelled aminoisobutyric acid for quantification of A-type amino acid transport. Finally, the effects of radiotherapy and chemotherapy on FDG uptake and the problems that accrue from these effects are reviewed. Both radiotherapy and chemotherapy can cause increased FDG uptake, complicating diagnosis and evaluation. Knowledge of the effects of different treatment procedures on regional FDG metabolism is therefore necessary for correct interpretation of the PET data.

Key words

Fluorine-18 deoxyglucose Positron emission tomography Specificity Aminoisobutyric acid Iterative image reconstruction 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Higashi K, Clavo AC, Wahl RL. Does FDG uptake measure proliferative activity of human cancer cells? In vitro comparison with DNA flow cytometry and triated thymidine uptake.J Nucl Med 1993; 34: 414–419.PubMedGoogle Scholar
  2. 2.
    Schad LR, Boesecke R, Schlegel W, Hartmann GH, Sturm V, Strauss LG, Lorenz WJ. Three dimensional image correlation of CT, MR and PET studies in radiotherapy treatment planning of brain tumors.J Comput Assist Tomogr 1987; 11: 948–954.PubMedGoogle Scholar
  3. 3.
    Doll J, Ostertag HJ, Bellemann ME, Schmidlin P, Kiibler WK, Strauss LG, Lorenz WJ. Effects of distorted PET projection data on the reconstructed image using different reconstruction algorithms. In: Bergmann H, Sinzinger H, eds.Radioactive isotopes in clinical medicine and research. Basel: Birkhäuser; 1995; 85–90.Google Scholar
  4. 4.
    Meyer MA. Diffusely increased colonic F-18 FDG uptake in acute enterocolitis.Clin Nucl Med 1995; 20: 434–435.PubMedGoogle Scholar
  5. 5.
    Bares R, Klever P, Hauptmann S, Hellwig D, Fass J, Cremerius U, Schmpelick V, Mittermayer C, Büll U. F-18 fluorodeoxyglucose PET in vivo evaluation of pancreatic glucose metabolism for detection of pancreatic cancer.Radiology 1994; 192: 79–86.PubMedGoogle Scholar
  6. 6.
    Stollfuss JC, Glatting G, Friess H, Kocher F, Beger HG, Reske SN. 2-(Fluorine-18)-fluoro-2-deoxy-D-glucose PET in detection of pancreatic cancer: value of quantitative image interpretation.Radiology 1995; 195: 339–344.PubMedGoogle Scholar
  7. 7.
    Inokuma T, Tamaki N, Torizuka T, Magata Y, Fujii M, Yonekura Y, Kajiyama T, Oshio G, Imamura M, Konishi J. Evaluation of pancreatic tumors with positron emission tomography and F-18-fluorodeoxyglucose: comparison with CT and US.Radiology 1995; 195: 345–352.PubMedGoogle Scholar
  8. 8.
    Kato T, Fukatsu H, Ito K, Tadokoro M, Ota T, Ikeda M, Isomura T, Ito S, Nishino M, Ishigaki T. Fluorodeoxyglucose positron emission tomography in pancreatic cancer: an unsolved problem.Eur J Nucl Med 1995; 22: 32–39.Google Scholar
  9. 9.
    Keyes JW Jr, Harkness BA, Greven KM, Williams DW III, Watson NE Jr, McGuirt WF. Salivary gland tumors: pretherapy evaluation with PET.Radiology 1994; 192: 99–102.PubMedGoogle Scholar
  10. 10.
    Inoue T, Kim EE, Komaki R, Wong FCL, Bassa P, Wong WH, Yang DJ, Endo K, Podoloff DA. Detecting recurrent or residual lung cancer with FDG-PET.J Nucl Med 1995; 36: 788–793.PubMedGoogle Scholar
  11. 11.
    Kubota R, Kubota K, Yamada S, Tada M, Ido T, Tamahashi N. Microamoradiographic study for the differentiation of intratumoral macrophages, granulation tissue and cancer cells by the dynamics of fluorine-18-fluorodeoxyglucose uptake.J Nucl Med 1994; 35: 104–112.PubMedGoogle Scholar
  12. 12.
    Conti PS. Synthesis of carbon-11 labeled biological molecules for the in vivo study of biochemical processes and structure-activity relationships in normal and malignant tissues. New York: Thesis; 1985; 65–82.Google Scholar
  13. 13.
    Duclos MJ, Chevalier B, Goddard C, Simon J. Regulation of amino acid transport and protein metabolism in myotubes derived from chicken muscle satellite cells by insulin-like growth factor-I.J Cell Physiol 1993; 157: 650–657.PubMedGoogle Scholar
  14. 14.
    Zamir O, Hasselgren PO, James H, Higashiguchi T, Fischer JE. Effect of tumor necrosis or interleukin-1 on muscle amino acid uptake and the role of glucocorticoids.Surg Gynecol Obstet 1993; 177: 27–32.PubMedGoogle Scholar
  15. 15.
    Rao BS. Radiation induced cellular lesions and their repair. In: Jain V, Goel H, Pohlit W, eds.Recent advances in radiation oncology. New Delhi: Publications and Information Directorate: 1990: 43–52.Google Scholar
  16. 16.
    Jain V, Kalia V, Dwarkanath BS, Singh SP. Modification of repair processes for improving tumour radiotherapy. In: Jain V, Goel H, Pohlit W eds.Recent advances in radiation oncology. New Delhi: Publications and Information Directorate; 1990: 103–121.Google Scholar
  17. 17.
    Engenhart R, Kimmig BN, Strauss LG, Höver KH, Romahn J, Haberkorn U, van Kaick G, Wannenmacher M. Therapy monitoring of presacral recurrences after high-dose irradiation. Value of PET, CT, CEA and pain score.Strahlenther Onkol 1992; 168: 203–212.PubMedGoogle Scholar
  18. 18.
    Engenhart R, Kimmig B, Höver KH, Strauss LG, Lorenz WJ, Wannenmacher M. Photon-neutron therapy for recurrent colorectal cancer — follow-up and preliminary results.Strahlenther Onkol 1990; 166: 95–98.PubMedGoogle Scholar
  19. 19.
    Rozental JM, Levine RL, Mehta MP, Kinsella TJ, Levin AB, Algan O, Mendoza M, Hanson JM, Schrader DA, Nickles RJ. Early changes in tumor metabolism after treatment: the effects of stereotactic radiotherapy.Int J Radiat Oncol Biol Phys 1991; 20: 1053–1060.PubMedGoogle Scholar
  20. 20.
    McCormick JL, Jette M, Potier M, Beliveau R, Johnstone RM. Molecular size of a Na(+)-dependent amino acid transporter in Ehrlich ascites cell plasma membranes estimated by radiation inactivation.Biochemistry 1991; 30: 3704–3709.PubMedGoogle Scholar
  21. 21.
    Haberkorn U, Reinhardt M, Strauss LG, Oberdorfer F, Berger MR, Altmann A, Wallich R, Dimitrakopoulou A, van Kaick G. Metabolic design of combination therapy: use of enhanced fluorodeoxyglucose uptake caused by chemotherapy.J Nucl Med 1992; 33: 1981–1987.PubMedGoogle Scholar
  22. 22.
    Minn H, Kangas L, Kellokumpu-Lehtinen P, Klemi P, Sipila H, Vuorinen J, Harkonen P, Lahde M. Uptake of 2-fluoro-2deoxy-d-[U-(14)C]glucose during chemotherapy in murine Lewis lung tumor.Nucl Med Biol Int J Radiat Appl Instrum 1992; 19: 55–63.Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • Ludwig G. Strauss
    • 1
  1. 1.Medical PET Group - Biological Imaging, Department of Oncological Diagnosis and TherapyGerman Cancer Research CenterHeidelbergGermany

Personalised recommendations