title: Occult lung infarction may induce false interpretation of 18F-FDG PET in primary staging of pulmonary malignancies.
abstract: OBJECTIVE
  The aim of the present report is to describe abnormal (18)F-fluorodeoxyglucose (FDG) accumulation patterns in the pleura and lung parenchyma in a group of lung cancer patients in whom lung infarction was present at the time of positron emission tomography (PET).
  
  
  METHODS
  Between November 2002 and December 2003, a total of 145 patients (102 males, 43 females; age range 38-85 years) were subjected to whole-body FDG PET for initial staging (n=117) or restaging (n=11) of lung cancer or for evaluation of solitary pulmonary nodules (n=17). Of these patients, 24 displayed abnormal FDG accumulation in the lung parenchyma that was not consistent with the primary lesion under investigation (ipsilateral n=12, contralateral n=9 or bilateral n=3). Without correlative imaging, this additional FDG uptake would have been considered indeterminate in differential diagnosis.
  
  
  RESULTS
  Of the 24 patients who were identified as having such lesions, six harboured secondary tumour nodules diagnosed as metastases, while in three the diagnosis of a synchronous second primary lung tumour was established. Additionally, nine patients were identified as having post-stenotic pneumonia and/or atelectasis (n=6) or granulomatous lung disease (n=3). In the remaining six (4% of all patients), a diagnosis of recent pulmonary embolism that topographically matched the additional FDG accumulation (SUV(max) range 1.4-8.6, mean 3.9) was made. Four of these six patients were known to have pulmonary embolism, and hence false positive interpretation was avoided by correlating the PET findings with those of the pre-existing diagnostic work-up. The remaining two patients were harbouring small occult infarctions that mimicked satellite nodules in the lung periphery. Based on histopathological results, the abnormal FDG accumulation in these two patients was attributed to the inflammatory reaction and tissue repair associated with the pathological cascade of pulmonary embolism.
  
  
  CONCLUSIONS
  In patients with pulmonary malignancies, synchronous lung infarction may induce pathological FDG accumulation that can mimic active tumour manifestations. Identifying this potential pitfall may allow avoidance of false positive FDG PET interpretation.
authors.affiliation: Division of Nuclear Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), CH-1011, Lausanne, Switzerland. Mohamed-Ehab.Kamel@hospvd.ch
authors.forename: Ehab M
authors.initials: EM
authors.lastname: Kamel
authors.forename: Thomas A
authors.initials: TA
authors.lastname: McKee
authors.forename: Maria-Lucia
authors.initials: ML
authors.lastname: Calcagni
authors.forename: Sabine
authors.initials: S
authors.lastname: Schmidt
authors.forename: Serge
authors.initials: S
authors.lastname: Markl
authors.forename: Sandra
authors.initials: S
authors.lastname: Castaldo
authors.forename: Angelika Bischof
authors.initials: AB
authors.lastname: Delaloye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
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