Pitfalls in positron emission tomography/computed tomography imaging: causes and their classifications

Area of Science:

• Medical Imaging
• Nuclear Medicine
• Radiology

Background:

• Positron emission tomography/computed tomography (PET/CT) is a vital diagnostic tool.
• Understanding imaging pitfalls is essential for accurate interpretation.
• Artifacts and unusual physiological uptake can mimic or obscure pathology.

Purpose of the Study:

• To systematically describe and classify pitfalls encountered in 18F-fluorodeoxyglucose (FDG) PET/CT imaging.
• To determine the incidence of various pitfalls and their impact on diagnostic decisions.
• To differentiate pitfalls from true pathological findings.

Main Methods:

• Retrospective review of 872 patient FDG PET/CT scans.
• Classification of pitfalls into artifacts (self-factor, equipment/technology-related) and infrequent physiological uptake.
• Analysis of pitfall incidence and influence on diagnostic outcomes.

Main Results:

• Pitfalls were identified in 78.4% of patients, with artifacts in 76.15%.
• The most frequent artifact was respiratory motion (57.5%), followed by injection site issues (13.88%).
• Infrequent physiological uptake occurred in 2.29% of patients; 13.4% of artifacts and 0.88% of physiological uptakes impacted diagnosis.

Conclusions:

• PET/CT imaging pitfalls are highly prevalent and diverse.
• Respiratory motion is the leading cause of artifacts.
• Accurate identification and differentiation of pitfalls from pathological uptakes are critical for clinical decision-making.