title: Pitfalls in radiation oncology. "Myocardial metastasis" in PET-CT after palliative radiation treatment of the left 5th rib.
abstract: BACKGROUND
  Positron emission tomography-computed tomography (PET-CT) is a useful diagnostic tool to detect metastases in patients with malignancy. False positives have been reported in cases of inflammation and tissue regeneration.
  
  
  METHODS
  Over a period of 2 years, a 32-year-old woman with hepatocellular carcinoma and multiple bone metastases received three treatments of radiation therapy to a bone metastasis in the 5th left rib. Restaging with [18F]fluorodeoxyglucose (FDG) PET-CT showed increased uptake within the cardiac apex highly suspicious for a myocardial metastasis. Because the patient was asymptomatic, additional magnetic resonance imaging (MRI) of the heart was performed demonstrating radiation-associated changes but no evidence for metastases.
  
  
  CONCLUSIONS
  PET-CT is a well-established diagnostic tool in metastatic diseases but its results should always be correlated with the clinical picture of the patient and previous treatments to rule out false positives.
authors.affiliation: Medical Faculty, Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Düsseldorf, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Kröpil
authors.forename: W
authors.initials: W
authors.lastname: Budach
authors.forename: E
authors.initials: E
authors.lastname: Bölke
authors.forename: P A
authors.initials: PA
authors.lastname: Gerber
authors.forename: F
authors.initials: F
authors.lastname: Zinnmann
authors.forename: H
authors.initials: H
authors.lastname: Hautzel
authors.forename: G
authors.initials: G
authors.lastname: Antoch
authors.forename: A
authors.initials: A
authors.lastname: Scherer
authors.forename: C
authors.initials: C
authors.lastname: Matuschek
mesh_terms: D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary*; D003951:Diagnostic Errors; D019788:Fluorodeoxyglucose F18; D006338:Heart Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging; D064847:Multimodal Imaging; D009206:Myocardium / Q000473:pathology*; D009367:Neoplasm Staging; D010166:Palliative Care; D049268:Positron-Emission Tomography; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000473:pathology; D011880:Radiotherapy Planning, Computer-Assisted; D012272:Ribs / Q000000981:diagnostic imaging* / Q000473:pathology / Q000528:radiation effects*; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18