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      The impact of infection and inflammation in oncologic 18F-FDG PET/CT imaging

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          Abstract

          Sites of infection and inflammation can be misleading in oncology PET/CT imaging because these areas commonly show 18F-FDG activity. Caution in the interpretation must be taken to avoid the misdiagnosis of malignancy. Utilization of both CT findings as well as patient history can help differentiate benign infectious and inflammatory processes from malignancy, although occasionally additional work-up may be required. This article discusses the mechanism of 18F-FDG uptake in infection and inflammation with illustrative examples.

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          SUV: standard uptake or silly useless value?

          Michelle Keyes (1995)
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            Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography.

            N Tamahashi, Elizabeth S. Yamada, Kazuo Kubota … (1992)
            While 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) is a useful tumor imaging agent, its intratumoral distribution has not been described well at the cellular level. In order to demonstrate cellular localization of [18F]FDG and 2-deoxy-D-[3H]glucose (3H-DG) uptake by the tumor in vivo, C3H/He mice transplanted subcutaneously with FM3A tumors were studied 1 hr after intravenous injection of [18F]FDG or 3H-DG using micro- and macro-autoradiography. Fluorine-18-FDG and 3H-DG showed the same distribution pattern in the tumor with both autoradiographic methods. The newly formed granulation tissue around the tumor and macrophages, which were massively infiltrating the marginal areas surrounding necrotic area of the tumor showed a higher uptake of [18F]FDG than the viable tumor cells. A maximum of 29% of the glucose utilization was derived from nontumor tissue in this tumor. The comparison of double-tracer autoradiographic distribution patterns of [18F]FDG and [6-3H]-thymidine showed the differences and the similarities between glucose utilization and the DNA synthesis. Whole proliferating tissue metabolizes [18F] FDG but not vice versa. High accumulation of [18F]FDG in the tumor is believed to represent high metabolic activity of the viable tumor cells. Our results showed that one should consider not only the tumor cells proper but also the non-neoplastic cellular elements, which appear in association with growth or necrosis of the tumor cells, for precise analysis of [18F]FDG uptake in tumor-bearing subjects, especially after anti-neoplastic treatment.
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              FDG PET of infection and inflammation.

              Charito Love, Maria B Tomas, Gene G Tronco … (2015)
              Nuclear medicine plays an important role in the evaluation of infection and inflammation. Fluorine 18 fluorodeoxyglucose (FDG) is a readily available radiotracer that offers rapid, exquisitely sensitive high-resolution tomography. In patients with acquired immunodeficiency syndrome, FDG positron emission tomography (PET) accurately helps localize foci of infection and is particularly useful for differentiating central nervous system lymphoma from toxoplasmosis. FDG PET can also help localize the source of fever of undetermined origin (FUO), thereby guiding additional testing. In the musculoskeletal system, FDG PET accurately helps diagnose spinal osteomyelitis, and in inflammatory conditions such as sarcoidosis and vasculitis, it appears to be useful for defining the extent of disease and monitoring response to treatment. FDG PET may be of limited usefulness in postoperative patients and in patients with a failed joint prosthesis or a tumor. Nevertheless, this relatively new imaging technique promises to be helpful in the diagnosis of infection and inflammation. FDG PET will likely assume increasing importance in assessing FUO, spinal osteomyelitis, vasculitis, and sarcoidosis and may even become the radionuclide imaging procedure of choice in the evaluation of some or all of these pathologic conditions. (c) RSNA, 2005.
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                Author and article information

                Journal
                Journal ID (nlm-journal-id): 8213295
                Journal ID (pubmed-jr-id): 1156
                Journal ID (nlm-ta): Biomed Pharmacother
                Journal ID (iso-abbrev): Biomed. Pharmacother.
                Title: Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie
                ISSN (Print): 0753-3322
                ISSN (Electronic): 1950-6007
                Publication date Nihms-submitted: 8 March 2020
                Publication date (Electronic): 01 July 2019
                Publication date (Print): September 2019
                Publication date PMC-release: 30 March 2020
                Volume: 117
                Page: 109168
                Affiliations
                [a ]Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
                [b ]Nuclear Medicine Service, Department of Veterans Affairs Health System, Ann Arbor, MI, USA
                [c ]Division of Drug Discovery and Pharmaceutical Sciences, Medical University of South Carolina, USA
                [d ]Department of Nuclear Medicine, Radiology, Neuroradiology, Interventional Radiology, Pathology, Santa Maria della Misericordia Hospital, Rovigo, Italy
                Author notes
                [* ]Corresponding author. domenico.rubello@ 123456aulss5.veneto.it (D. Rubello)
                [** ]Corresponding author at: Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA. dwale@ 123456med.umich.edu (D.J. Wale)
                Article
                Manuscript ID: NIHMS1571206
                DOI: 10.1016/j.biopha.2019.109168
                PMC ID: 7104808
                PubMed ID: 31334700
                SO-VID: e4f990f9-c154-47cd-887d-17ba17297adf
                License:

                This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/BY-NC-ND/4.0/).

                History
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                Subject: Article

                Keywords: 18f-fdg pet/ct,infection,inflammation,imaging pitfalls
                Data availability:
                Keywords: 18f-fdg pet/ct, infection, inflammation, imaging pitfalls

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