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Where can FDG-PET contribute most to anatomical imaging problems?

Radiological Sciences, 5th Floor TGH, Guy's Hospital, London SE1 9RT, UK

View larger version (103K): [in a new window]   Figure 1. (a) Coronal STIR images in a patient with neurofibromatosis and pain in the left arm. A number of small neurofibromata are visible but no identifiable cause of pain. (b) An FDG-PET scan shows a high uptake tumour in the left brachial plexus. (c) A repeat MR scan with a body coil confirms the tumour. This was surgically excised and found to be a neurofibrosarcoma.

View larger version (65K): [in a new window]   Figure 2. (a) CT scan through the chest of a patient with lung cancer showing a small right paratracheal node. (b) The FDG-PET scan shows high uptake in the primary tumour and (c) uptake in the right paratracheal node.

View larger version (77K): [in a new window]   Figure 3. (a). A whole body FDG-PET scan confirms a large tumour in the right lung. (b) Comparison of the PET scan and CT shows that there is also a lesion in the left chest wall and (c) in the liver which had not been appreciated when the CT scan was first read.

View larger version (54K): [in a new window]   Figure 4. (a) This patient had had a previous lobectomy for carcinoma of the lung and now has a small anterior mediastinal nodule but was a high risk for biopsy. (b) The FDG-PET scan confirms high uptake in the nodule indicating that biopsy is worthwhile.

View larger version (64K): [in a new window]   Figure 5. (a) An axial T2W series through the brainstem of a 2 year old with neurofibromatosis and recent cranial nerve palsy shows swelling of the pons but with little signal change. (b) The sagittal T1W images through the midline confirmed the swelling but no enhancement. (c) A PET scan with methionine (above) and FDG (below) showed increased uptake, making biopsy likely to be of benefit despite the hazardous site. A fibrillary grade II astrocytoma was confirmed.

View larger version (54K): [in a new window]   Figure 6. (a) This man had a previously radiotherapy treated glioblastoma multiforme in the left parieto-occipital region. A T1W axial series showed a ring-enhancing lesion at the site of the previous tumour. The concern was whether this was recurrence of the tumour or radiation necrosis. (b) The PET scan (methionine above and FDG below) showed uptake in the abnormality, indicating it was likely to be tumour recurrence. This was confirmed by biopsy and the patient subsequently died from progression of the tumour.

View larger version (90K): [in a new window]   Figure 7. (a) An axial T2W image in an HIV positive male shows abnormal signal in the left cerebellar peduncle extending into the pons. This rapidly progressed. The coronal T1W image after contrast (b) did not show significant enhancement and the concern was whether this might be lymphoma rather than progressive multifocal leucoencephalopathy. (c) The FDG-PET scan shows no significant uptake, indicating that progressive multifocal leucoencephalopathy was more likely. This was confirmed by biopsy.

View larger version (80K): [in a new window]   Figure 8. (a) A PET scan was performed on a patient with previously resected gastric carcinoma because of subcarinal abnormality which was thought could be a post-operative collection and (b) a granuloma at the right hilum. Both abnormalities showed intense uptake of FDG, indicating metastatic disease.

View larger version (83K): [in a new window]   Figure 9. (a) A contrast enhanced CT of the liver in a patient who had received laser therapy to a solitary right lobe metastasis showed a low density laser defect. (b) and (c) T1W images before and after intravenous Gd-DTPA show two faint rounded enhancing lesions in the left lobe. (d) A PET-FDG scan confirms multiple high uptake metastases.

View larger version (51K): [in a new window]   Figure 10. (a) A CT scan through the neck of a man with a previously resected Hurtle cell carcinoma was equivocal for recurrence in the right thyroid bed. (b) A PET-FDG scan confirms high intensity uptake in the right side with recurrence confirmed by surgery.

View larger version (47K): [in a new window]   Figure 11. An FDG-PET registration study in a patient with recurrent tumour in the right maxilla showing good matching of isotope uptake with the tumour visible in the T1W MR images.

View larger version (96K): [in a new window]   Figure 12. (a) and (b) Sagittal STIR and axial fat suppressed T1W images in a patient with a small mass in the left thigh. This shows only mild uptake of FDG in (c) and was confirmed surgically to be a small haemangioma.

View larger version (71K): [in a new window]   Figure 13. (a) Axial fat-suppressed post-contrast T1W images after contrast show a large necrotic mass in the left thigh with an enhancing rim. (b) Local views of the tumour in the thigh confirm a highly metabolic margin. (c) Whole body views show that the patient has multiple deposits in the lungs.