Cosmetic Filler and PET Positivity: The Risk of a False Positive.

Area of Science:

• Oncology
• Radiology
• Dermatology

Background:

• Positron emission tomography (PET) imaging is crucial for cancer surveillance, but its interpretation can be complicated by non-specific findings.
• Hyaluronic acid (HA) fillers are commonly used for cosmetic and reconstructive purposes, and their metabolic activity on PET scans is not widely understood.
• Distinguishing true tumor recurrence from benign post-procedural changes is critical for patient management and anxiety reduction.

Approach:

• A case report detailing a patient with angiosarcoma who developed PET-avid findings after HA filler injection.
• Retrospective review of PET-MRI scans to assess the characteristics of HA filler uptake.
• Comprehensive literature review on the presentation of fillers on PET imaging.

Key Points:

• Hyaluronic acid filler injection in a patient with a history of angiosarcoma led to false-positive PET-MRI findings suggestive of local recurrence.
• The patient exhibited increased standardized uptake value (SUV) in the area of filler placement, raising concern for malignancy.
• Advanced MRI sequences helped confirm the findings were consistent with HA filler augmentation, not tumor recurrence.

Conclusions:

• Hyaluronic acid fillers can demonstrate increased SUV on PET-CT scans, potentially leading to false-positive results for malignancy.
• Otolaryngologists and other clinicians must be aware of this imaging artifact to ensure accurate patient counseling.
• Recognition of filler-related PET avidity can prevent unnecessary invasive procedures and reduce patient anxiety.