Skip to main content

Advertisement

SpringerLink
Log in

FDG PET/CT in the liver: lesions mimicking malignancies

  • Pictorial Essay
  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

Purpose

18F-fluorodeoxyglucose (FDG) PET/CT is invaluable in managing liver lesions, in particular in the evaluation of suspected liver metastases. It is both sensitive and specific in detecting liver metastases from a wide range of primary cancers, and may change clinical management, most commonly by detecting additional lesions and decreasing the number of futile surgeries. However, some benign lesions may also show increased metabolic activity which can lead to false positive PET findings. We describe some of these lesions and their imaging characteristics that may help in differentiating them from malignant metastases.

Methods

We reviewed all whole body FDG PET/CT studies performed over a 5-year period in our institution, and identified those with focal liver lesions showing increased FDG uptake for which histological results were available.

Results

A majority of lesions showing increased metabolic activity were due to malignant disease, such as metastases or primary liver tumours. However, we also found increased FDG uptake in non-neoplastic lesions such as Cryptococcosis, abscesses, and secondary inflammation from cholecystitis. Increased metabolic activity was also seen in some benign neoplasms such as hepatic adenomas and hemangioendotheliomas.

Conclusion

FDG PET/CT is currently the most sensitive non-invasive imaging modality for the detection of hepatic metastases, particularly from the gastrointestinal tract. False positive results are rare, and have been described mainly in abscesses. However, other lesions can also show increased metabolic activity, and failure to differentiate these from metastases may result in inappropriate treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Khandani AH, Wahl RL (2005) Applications of PET in liver imaging. Radiol Clin N Am 43:849–860

    Article  PubMed  Google Scholar 

  2. Brant WE (1998) Liver. In: Webb WR, Brant WE, Helms CA (eds) Fundamentals of Body CT, 2nd edn. Philadelphia: WB Saunders, pp 195–212

    Google Scholar 

  3. Lai DT, Fulham M, Stephen MS, et al. (1996) The role of whole-body positron emission tomography with [18F] fluorodeoxyglucose in identifying operable colorectal cancer metastases to the liver. Arch Surg 131:703–707

    Article  CAS  PubMed  Google Scholar 

  4. Kinkel K, Lu Y, Both M, Warren RS, Thoeni RF (2002) Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis. Radiology 224:748–756

    Article  PubMed  Google Scholar 

  5. Bipat S, van Leeuwen MS, Comans EF, et al. (2005) Colorectal liver metastases: CT, MR imaging, and PET for diagnosis-meta-analysis. Radiology 237:123–131

    Article  PubMed  Google Scholar 

  6. Wiering B, Vogel WV, Ruers TJ, Oyen WJ (2008) Controversies in the management of colorectal liver metastases: role of PET and PET/CT. Dig Surg 25:413–420

    Article  PubMed  Google Scholar 

  7. Yamaguchi A, Kurosaka Y, Kanno M, et al. (1993) Analysis of hepatic recurrence of colorectal cancer after resection of hepatic metastases. Int Surg 78:16–19

    CAS  PubMed  Google Scholar 

  8. Nordlinger B, Guiguet M, Vaillant JC, et al. (1996) Surgical resection of colorectal carcinoma metastases to the liver: a prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer 77:1254–1262

    Article  CAS  PubMed  Google Scholar 

  9. Gayowski TJ, Iwatsuki S, Madariaga JR, et al. (1994) Experience in hepatic resection for metastatic colorectal cancer: analysis of clinical and pathologic risk factors. Surgery 116:703–710

    CAS  PubMed Central  PubMed  Google Scholar 

  10. Delbeke D, Vitola JV, Sandler MP, et al. (1997) Staging recurrent metastatic colorectal carcinoma with PET. J Nucl Med 38:1196–1201

    CAS  PubMed  Google Scholar 

  11. Abdel-Nabi H, Doerr RJ, Lamonica DM, et al. (1998) Staging of primary colorectal carcinomas with fluorine-18 fluorodeoxyglucose whole-body PET: correlation with histopathologic and CT findings. Radiology 206:755–760

    CAS  PubMed  Google Scholar 

  12. Topal B, Flamen P, Aerts R, et al. (2001) Clinical value of whole-body emission tomography in potentially curable colorectal liver metastases. Eur J Surg Oncol 27:175–179

    Article  CAS  PubMed  Google Scholar 

  13. Sacks A, Peller PJ, Surasi DS, et al. (2011) Value of PET/CT in the management of liver metastases, part 1. AJR Am J Roentgenol. 197:W256–W259

    Article  PubMed  Google Scholar 

  14. D’Souza MM, Sharma R, Mondal A, et al. (2009) Prospective evaluation of CECT and 18F-FDG-PET/CT in detection of hepatic metastases. Nucl Med Commun 30:117–125

    Article  PubMed  Google Scholar 

  15. Grassetto G, Fornasiero A, Bonciarelli G, et al. (2010) Additional value of FDG-PET/CT in management of “solitary” liver metastases: preliminary results of a prospective multicenter study. Mol Imaging Biol 12:139–144

    Article  PubMed  Google Scholar 

  16. Briggs RH, Chowdhury FU, Lodge JP, Scarsbrook AF (2011) Clinical impact of FDG PET-CT in patients with potentially operable metastatic colorectal cancer. Clin Radiol 66:1167–1174

    Article  CAS  PubMed  Google Scholar 

  17. Engledow AH, Skipworth JR, Pakzad F, et al. (2012) The role of 18FDG PET/CT in the management of colorectal liver metastases. HPB (Oxford) 14:20–25

    Article  Google Scholar 

  18. O’Connor OJ, McDermott S, Slattery J, Sahani D, Blake MA (2011) The use of PET-CT in the assessment of patients with colorectal carcinoma. Int J Surg Oncol 2011:846512.

  19. Khan MA, Combs CS, Brunt EM, et al. (2000) Positron emission tomography scanning in the evaluation of hepatocellular carcinoma. J Hepatol 32:792–797

    Article  CAS  PubMed  Google Scholar 

  20. Wudel LJ Jr, Delbeke D, Morris D, et al. (2003) The role of [18F] fluorodeoxyglucose positron emission tomography imaging in the evaluation of hepatocellular carcinoma. Am Surg 69:117–124

    PubMed  Google Scholar 

  21. Blake MA, Singh A, Setty BN, et al. (2006) Pearls and pitfalls in interpretation of abdominal and pelvic PET-CT. Radiographics 26:1335–1353

    Article  PubMed  Google Scholar 

  22. Anderson CD, Rice MH, Pinson CW, et al. (2004) Fluorodeoxyglucose PET imaging in the evaluation of gallbladder carcinoma and cholangiocarcinoma. J Gastrointest Surg 8:90–97

    Article  PubMed  Google Scholar 

  23. Wiering B, Krabbe PF, Jager GJ, Oyen WJ, Ruers TJ (2005) The impact of fluor-18-deoxyglucose-positron emission tomography in the management of colorectal liver metastases. Cancer 104:2658–2670

    Article  PubMed  Google Scholar 

  24. Niekel MC, Bipat S, Stoker J (2010) Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment. Radiology 257:674–684

    Google Scholar 

  25. Delbeke D, Martin WH, Sandler MP, et al. (1998) Evaluation of benign vs malignant hepatic lesions with positron emission tomography. Arch Surg 133:510–515

    Article  CAS  PubMed  Google Scholar 

  26. Kurtaran A, Becherer A, Pfeffel F, et al. (2000) 18F-fluorodeoxyglucose (FDG)-PET features of focal nodular hyperplasia (FNH) of the liver. Liver 20:487–490

    Article  CAS  PubMed  Google Scholar 

  27. Son HB, Han CJ, Kim BI, et al. (2002) Evaluation of various hepatic lesions with positron emission tomography (in Korean). Taehan Kan Hakhoe Chi 8:472–480

    PubMed  Google Scholar 

  28. Igai H, Gotoh M, Yokomise H (2006) Computed tomography (CT) and positron emission tomography with [18F] fluoro-2-deoxy-d-glucose (FDG-PET) images of pulmonary cryptococcosis mimicking lung cancer. Eur J Cardiothorac Surg 30:837–839

    Article  PubMed  Google Scholar 

  29. Seshadri N, Kaur B, Balan K (2007) Disseminated cryptococcosis: detection by F-18 FDG PET. Clin Nucl Med 32:476–478

    Article  CAS  PubMed  Google Scholar 

  30. Patel PM, Alibazoglu H, Ali A, Fordham E, LaMonica G (1997) ‘False-positive’ uptake of FDG in a hepatic adenoma. Clin Nucl Med 22:490–491

    Article  CAS  PubMed  Google Scholar 

  31. Grazioli L, Federle MP, Brancatelli G, et al. (2001) Hepatic adenomas: imaging and pathologic findings. Radiographics 21:877–892

    Article  CAS  PubMed  Google Scholar 

  32. Weiss SW, Enzinger FM (1982) Epithelioid hemangioendothelioma: a vascular tumor often mistaken for a carcinoma. Cancer 50:970–981

    Article  CAS  PubMed  Google Scholar 

  33. Woo RK, Albanese CT (2008) Pediatric Surgery. In: Norton JA, Barie PS, Bollinger RR, et al. (eds) Surgery: Basic Science and Clinical Evidence, 2nd edn. New York: Springer, p 684

    Google Scholar 

  34. Lyburn ID, Torreggiani WC, Harris AC, et al. (2003) Hepatic epithelioid hemangioendothelioma: sonographic, CT, and MR imaging appearances. AJR Am J Roentgenol 180:1359–1364

    Article  PubMed  Google Scholar 

  35. Ros LH, Fernandez L, Villacampa VM, Ros PR (1999) Epithelioid hemangioendothelioma of the liver: characteristics on magnetic resonance imaging: case report. Can Assoc Radiol J 50:387–389

    CAS  PubMed  Google Scholar 

  36. Kehagias DT, Moulopoulos LA, Antoniou A, et al. (2000) Hepatic epithelioid hemangioendothelioma: MR imaging findings. Hepatogastroenterology 47:1711–1713

    CAS  PubMed  Google Scholar 

  37. Osman MM, Cohade C, Nakamoto Y, et al. (2003) Clinically significant inaccurate localization of lesions with PET-CT: frequency in 300 patients. J Nucl Med 44:240–243

    PubMed  Google Scholar 

  38. Böhm B, Voth M, Geoghegan J, et al. (2004) Impact of positron emission tomography on strategy in liver resection for primary and secondary liver tumors. J Cancer Res Clin Oncol 130:266–272

    Article  PubMed  Google Scholar 

  39. Boellaard R, O’Doherty MJ, Weber WA, et al. (2010) FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging 37:181–200

    Article  PubMed Central  PubMed  Google Scholar 

  40. Routhier JR, Woodfield CA, Mayo-Smith WW (2009) AJR teaching file: fat-containing retroperitoneal mass presenting with acute flank pain. AJR Am J Roentgenol 192:S122–S124

    Article  PubMed  Google Scholar 

  41. Vogel WV, Oyen WJ, Barentsz JO, Kaanders JH, Corstens FH (2004) PET/CT: panacea, redundancy, or something in between? J Nucl Med 45(Suppl 1):15S–24S

    PubMed  Google Scholar 

  42. Kim YJ, Yun M, Lee WJ, Kim KS, Lee JD (2003) Usefulness of 18F-FDG PET in intrahepatic cholangiocarcinoma. Eur J Nucl Med Mol Imaging 30:1467–1472

    Article  PubMed  Google Scholar 

  43. Lam WW, Osmany S (2009) Biliary non-Hodgkin lymphoma detected by F-18 FDG PET/CT. Clin Nucl Med 34:791–792

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore

    Gerald Jit Shen Tan

  2. Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore

    Gerald Jit Shen Tan

  3. Centre for PET, Austin Health, Heidelberg, VIC, Australia

    Gerald Jit Shen Tan, Salvatore Ugo Berlangieri, Sze Ting Lee & Andrew Mark Scott

  4. Ludwig Institute for Cancer Research, 145 Studley Road, Heidelberg, VIC, 3084, Australia

    Salvatore Ugo Berlangieri, Sze Ting Lee & Andrew Mark Scott

Authors
  1. Gerald Jit Shen Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Salvatore Ugo Berlangieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sze Ting Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrew Mark Scott
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gerald Jit Shen Tan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tan, G.J.S., Berlangieri, S.U., Lee, S.T. et al. FDG PET/CT in the liver: lesions mimicking malignancies. Abdom Imaging 39, 187–195 (2014). https://doi.org/10.1007/s00261-013-0043-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-013-0043-3

Keywords

Search

Navigation