Image-guided biopsy: what the interventional radiologist needs to know about PET/CT

Positron emission tomography (PET)/computed tomography (CT) with fluorine 18 fluorodeoxyglucose (FDG) is increasingly used in evaluation of oncology patients. Because PET/CT can demonstrate malignancy before morphologic changes are evident, application of PET/CT information to image-guided biopsy ca...

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Bibliographic Details
Published in:	Radiographics Vol. 32; no. 5; pp. 1483 - 1501
Main Authors:	Kobayashi, Katsuhiro, Bhargava, Peeyush, Raja, Shanker, Nasseri, Farbod, Al-Balas, Hassan A, Smith, Darryl D, George, Sharad P, Vij, Meena S
Format:	Journal Article
Language:	English
Published:	United States 01-09-2012
Subjects:	Adult Aged Female Fluorodeoxyglucose F18 Humans Image Enhancement - methods Image-Guided Biopsy - methods Male Middle Aged Multimodal Imaging - methods Neoplasms - diagnosis Positron-Emission Tomography Radiography, Interventional - methods Radiopharmaceuticals Tomography, X-Ray Computed
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Summary:	Positron emission tomography (PET)/computed tomography (CT) with fluorine 18 fluorodeoxyglucose (FDG) is increasingly used in evaluation of oncology patients. Because PET/CT can demonstrate malignancy before morphologic changes are evident, application of PET/CT information to image-guided biopsy can facilitate early histologic diagnosis and staging. However, because FDG uptake is not specific to cancer, PET/CT findings may raise questions about whether uptake in a lesion is an indication for biopsy. To properly select patients for image-guided biopsy, interventional radiologists should be familiar with the biologic significance of FDG uptake and various causes of false-positive uptake. PET/CT images may also become a source of confusion in the interpretation of biopsy results. Various causes of false-positive and false-negative FDG uptake need to be considered, especially when there is a discrepancy between biopsy results and PET/CT findings. False-negative FDG uptake can result from cancers that are too small to be observed or not FDG avid. False-positive FDG uptake can be due to underlying inflammation from recent treatment. Conversely, complete resolution of FDG uptake in a treated lesion does not necessarily indicate absence of viable cells. When questions about PET/CT findings arise in the context of image-guided biopsy, discussion with experienced nuclear imaging physicians is essential.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0271-5333 1527-1323
DOI:	10.1148/rg.325115159