Focal Liver Uptake on FDG PET/CT Without CT Correlate: Utility of MRI in the Evaluation of Patients With Known Malignancy
Araki T, Mouhieddine TH, Tirumani SH, Gujrathi R, Shinagare AB, Ramaiya NH, Jagannathan JP
OBJECTIVE. The purpose of this study was to determine the significance and utility of MRI in evaluation of focal hepatic uptake on FDG PET/CT without a CT correlate in patients with known malignancy.
MATERIALS AND METHODS. In this retrospective study, we identified 36 of 1851 patients between 2005 and 2012 with known malignancy (19 women, 17 men; mean age, 56.1 years old) who had focal hepatic uptake on FDG PET/CT without a CT correlate and follow-up MRI within 100 days for assessment of uptake. Two radiologists reviewed the FDG PET/CT images together, reached consensus about presence of focal hepatic uptake, and measured maximum standardized uptake value (SUVmax) of the focal uptake and background liver. MR images were then reviewed to identify any correlate. Follow-up imaging and histopathologic data were reviewed to confirm or refute metastasis. Statistical correlation between intensity of FDG uptake and presence of focal lesions on MRI was performed.
RESULTS. Fifty sites of focal hepatic uptake without CT correlate were identified. The median SUVmax was 4.1 (range, 2.1-10.1), whereas the ratio of median SUVmax of the hepatic lesion to that of normal parenchyma was 1.3 (range, 0.98-2.6). MRI confirmed focal lesions in 26 of 50 sites (52%). Seventy-seven percent of cases of hepatic uptake with an MRI correlate (20/26) were confirmed as metastatic disease (six cases at histopathology). Therefore, 40% of cases of hepatic uptake without a CT correlate (20/50) were metastases. We found no statistically significant difference in the SUVmax of hepatic lesions and SUVmax ratio between the groups with and without an MRI correlate (median SUVmax = 3.85 vs 4.2, p = 0.5; SUVmax ratio = 1.32 vs 1.31, p = 0.97) as well as between the groups with the final diagnosis of benign lesions and metastasis (SUVmax = 4.05 vs 3.95, p = 0.64; SUVmax ratio = 1.31 vs 1.32, p = 0.91).
CONCLUSION. More than half of the cases of focal hepatic uptake on PET/CT without a CT correlate had an MRI correlate in our study, and more than 75% of these lesions were metastases, regardless of SUVmax.
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