Evidence-based management of incidental focal uptake of fluorodeoxyglucose on PET-CT
Open accessAbstract
Focal incidental uptake, with or without CT abnormalities, is a common finding on fluorodeoxyglucose PET/CT and evidence-based management for this type of uptake is lacking. This article reviews the evidence on focal incidental uptake including the incidence of malignancy, differential diagnosis and imaging criteria which can be used to further characterize it. The article focusses on PET rather than CT criteria. The strength of the evidence base is highly variable ranging from systematic reviews and meta-analyses to a virtual absence of evidence. Caution needs to be used when using standardized uptake values (SUVs) reported in other studies due to interpatient and institution observed variation in SUVs. There is sufficient evidence to permit specific suggestions on how to interpret the foci and recommend further management in the: pituitary (investigate when SUVmax >4.1), thyroid (investigate all), breast (investigate all), lung parenchyma (if focus of fluorodeoxyglucose without a CT nodule, no further investigations), colon (investigate all foci with SUVmax >5.9, urgently if SUVmax >11.4), adrenals (criteria depend on if patient has cancer) and prostate gland (investigate in males aged >50 years or >40 years if peripheral uptake or patient has other risk factors). There is some evidence to guide further management for the parotid gland, naso-orophaynx, oesophagus, pancreas, uterus and ovaries. There is insufficient evidence to guide management for the liver, spleen, kidneys, gallbladder, testis and bone, for these organs patient characteristics and other guidelines will likely be of more use in determining further management.
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Despite PBMAH being benign, limited studies using FDG uptake demonstrated uptake similar to malignant tumors.
“Despite PBMAH being a benign disease limited studies using FDG uptake demonstrated an uptake similar to that seen in malignant tumors (326).”
From Adrenal incidentaloma (2020) · cites this paper as [326]
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Sherlock, M., Scarsbrook, A., Abbas, A., Fraser, S., Limumpornpetch, P., Dineen, R., & Stewart, P. M. (2020) · Endocrine Reviews · doi:10.1210/endrev/bnaa008 · Cited by 347 · see citing works
“Despite PBMAH being a benign disease limited studies using FDG uptake demonstrated an uptake similar to that seen in malignant tumors (326).”
ResultNon-oncologic incidental uptake on FAPI PET/CT imaging
Hotta, M., Rieger, A. C., Jafarvand, M. G., Menon, N., Farolfi, A., Benz, M., & Calais, J. (2022) · British Journal of Radiology · doi:10.1259/bjr.20220463 · Cited by 107 · see citing works
de Leijer, J. F., Metman, M. J. H., van der Hoorn, A., Brouwers, A. H., Kruijff, S., van Hemel, B. M., Links, T. P., & Westerlaan, H. E. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.723394 · Cited by 58 · see citing works
Iqbal, R., Mammatas, L. H., Aras, T., Vogel, W. V., van de Brug, T., Oprea‐Lager, D. E., Verheul, H. M. W., Hoekstra, O. S., Boellaard, R., & van Oordt, C. W. M. D. H. (2021) · Diagnostics · doi:10.3390/diagnostics11111954 · Cited by 20 · see citing works
Incremental diagnostic utility of gastric distension FDG PET/CT
Roux, P. L., Duong, C. P., Cabalag, C. S., Parameswaran, B. K., Callahan, J., & Hicks, R. J. (2015) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-015-3211-6 · Cited by 19 · see citing works
“PET/CT Variants and Pitfalls in Lung Cancer and Mesothelioma”
Lopci, E., Kobe, C., Gnanasegaran, G., Adam, J. A., & de Geus‐Oei, L. (2021) · Seminars in Nuclear Medicine · doi:10.1053/j.semnuclmed.2021.04.002 · Cited by 18 · see citing works
Elangovan, S. M., & Sebro, R. (2019) · World Journal of Radiology · doi:10.4329/wjr.v11.i6.81 · Cited by 15 · see citing works
Aarstad, E. M., Nordhaug, P., Naghavi‐Behzad, M., Larsen, L. B., Gerke, O., & Hildebrandt, M. G. (2019) · European Journal of Hybrid Imaging · doi:10.1186/s41824-019-0063-5 · Cited by 14 · see citing works
Maliha, P. G., Hotta, M., Farolfi, A., Grogan, T., Alano, R. M., Limon, A., Lam, E., Carlucci, G., Bahri, S., Salavati, A., et al. (2024) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-024-06733-7 · Cited by 13 · see citing works
Prevalence and Clinical Significance of Incidental Focal 18F-FDG Uptake in Colon on PET/CT Imaging
Gökden, Y., Özülker, F., & Özülker, T. (2022) · Molecular Imaging and Radionuclide Therapy · doi:10.4274/mirt.galenos.2022.38247 · Cited by 9 · see citing works
Roddy, S., Biggans, T. J., raofi, A. K., Kanodia, A. K., Sudarshan, T. A. P., & Ramkumar, P. G. (2020) · European Journal of Hybrid Imaging · doi:10.1186/s41824-020-00089-5 · Cited by 7 · see citing works
Incidental uptake of fluorodeoxyglucose in the Waldeyer’s ring and risk of oropharyngeal malignancy
Bujoreanu, I., Gujral, D. M., Wallitt, K. L., & Awad, Z. (2021) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-021-07089-6 · Cited by 7 · see citing works
Prevalence and clinical significance of incidental 18F-FDG uptake in the pituitary
Signore, G., Meyer, M., Albano, D., Bertagna, F., Lalonde, M. N., Schaefer, N. G., Giovanella, L., Prior, J. O., & Treglia, G. (2020) · Clinical and Translational Imaging · doi:10.1007/s40336-020-00375-z · Cited by 5 · see citing works
Lam, M., Burke, C. J., & Walter, W. R. (2021) · Diagnostic and Interventional Radiology · doi:10.5152/dir.2021.20438 · Cited by 4 · see citing works
Parotid gland metastasis of lung adenocarcinoma identified on surveillance 18F-FDG PET/CT
Soputro, N. A., Asairinachan, A., & Prasad, J. (2022) · BMJ Case Reports · doi:10.1136/bcr-2021-246779 · Cited by 4 · see citing works
Incidental anal 18fluorodeoxyglucose uptake: Should we further examine the patient?
Moussaddaq, A.-S., Brochard, C., Palard-Novello, X., Garin, É., Wallenhorst, T., Balc’h, E. L., l'Héritier, A. M., Grainville, T., Siproudhis, L., & Lièvre, A. (2020) · World Journal of Clinical Cases · doi:10.12998/wjcc.v8.i17.3679 · Cited by 3 · see citing works
Actionable imaging findings in the daily PET/CT scenario
Mattana, F., Zanoni, L., Nanni, C., Mosconi, C., Brocchi, S., Golfieri, R., & Fanti, S. (2023) · Clinical and Translational Imaging · doi:10.1007/s40336-023-00544-w · Cited by 3 · see citing works
Panda, A., McCarthy, M. R., Murray, J. A., Sharain, R. F., Shi, M., & Kendi, A. T. (2021) · Europe PMC (PubMed Central) · doi:10.22038/aojnmb.2020.49000.1333 · Cited by 3 · see citing works
Kayadibi, Y., Karagöz, S. H., Kurt, S. A., Kargın, O. A., Güneren, C., Şahin, O. E., Hamid, R., & YILMAZ, M. H. (2024) · Academic Radiology · doi:10.1016/j.acra.2024.11.031 · Cited by 3 · see citing works
The role of PET/CT in oncogynecology (literature review)
Николаева, Е. А., Тарачкова, Е. В., Sheikh, Z. V., & Tyurin, I. E. (2023) · Medical Visualization · doi:10.24835/1607-0763-1198 · Cited by 2 · see citing works
Polymer clip granuloma mimicking lymph node recurrence: a case report
Kimura, S., Honda, M., & Sanmoto, Y. (2024) · Surgical Case Reports · doi:10.1186/s40792-024-01881-2 · Cited by 2 · see citing works
Pituitary and other sellar region metastases
Rodrigues, M. L. D., & Abucham, J. (2018) · Current Opinion in Endocrine and Metabolic Research · doi:10.1016/j.coemr.2018.05.001 · Cited by 2 · see citing works
Wakfie-Corieh, C. G., Rey, C. R., Candil, A. O., Ferrando‐Castagnetto, F., Valhondo-Rama, R., Tolón, M. R., Martín, A. P., & Delgado, J. L. C. (2021) · Nuclear Medicine Communications · doi:10.1097/mnm.0000000000001369 · Cited by 1 · see citing works
Wong, W. C. (2022) · Nuclear Medicine and Molecular Imaging · doi:10.1007/s13139-022-00771-5 · Cited by 1 · see citing works
Key, S., Chia, C., Magarey, M. J. R., & Dixon, B. J. (2023) · ANZ Journal of Surgery · doi:10.1111/ans.18839 · Cited by 1 · see citing works
Oncologic significance of unexpected osseous foci on FDG-PET without correlative CT abnormalities
Zamora, E., & Valdivia, A. Y. (2021) · Annals of Nuclear Medicine · doi:10.1007/s12149-020-01572-6
Ng, K., Hui, Y., Chu, K., Kung, B., & Au-Yong, T. K. (2021) · Hong Kong Journal of Radiology · doi:10.12809/hkjr2117186
Oesophageal cancer - incidental (PET-CT)
Keshavamurthy, J. H. (2019) · Radiopaedia.org · doi:10.53347/rid-71777
Zeghari, H. (2022) · Elsevier eBooks · doi:10.1016/b978-2-294-77990-9.00009-2
Melgar, S., Pardal-Refoyo, J. L., & Tamayo, P. (2023) · Revista ORL · doi:10.14201/orl.29558
Ossifying fibroma presented as an incidental [18F]FDG PET/CT uptake within the hard palate
Satja, M., Bunnag, N., & Vachatimanont, S. (2023) · Nuclear Medicine Review · doi:10.5603/nmr.2023.0014
Patır, D. Ç., Agüloğlu, N., Binicier, Ö., & Ceylan, C. (2023) · The Anatolian Journal of General Medical Research · doi:10.4274/anatoljmed.2022.67984
Sluijter, T. E., Yakar, D., Roest, C., Tsoumpas, C., & Kwee, T. C. (2024) · Clinical Imaging · doi:10.1016/j.clinimag.2024.110116
More is missed by not looking – incidental findings on FDG-PET
Lee, J. C., Chong, J. W., & Hartnett, G. F. (2024) · Clinical Imaging · doi:10.1016/j.clinimag.2024.110186
van Olmen, J. P., Schrijver, A. M., Stokkel, M. P. M., Loo, C. E., Gunster, J. L. B., Peeters, M.-J. T. F. D. V., van Duijnhoven, F. H., & van der Ploeg, I. M. C. (2024) · Breast Cancer Research and Treatment · doi:10.1007/s10549-024-07331-9
Mølstrøm, J., Lange, N. G. E., Pareek, M., Thomassen, A., Nielsen, A., Høilund‐Carlsen, P. F., Godballe, C., & Rohde, M. (2024) · Diagnostics · doi:10.3390/diagnostics14232764
Cao, Y., Kako, B., Sedeh, A. E., Deffler, C., Ng, T. S. C., Chow, D. Z., Tajmir, S., Klempner, S. J., Strickland, M. R., Mahmood, U., et al. (2025) · Abdominal Radiology · doi:10.1007/s00261-025-05257-4
Clinical significance of incidental focal [18F]-FDG uptake in small bowel on PET-CT
Su, J. Z., Taylor, S. A., Fala, M., Planche, K., & Wagner, T. (2025) · British Journal of Radiology · doi:10.1093/bjr/tqaf287
Self-citationJabri, F. S. A., Salmi, I. S. A., & Al-Nabhani, K. Z. (2026) · Indian Journal of Nuclear Medicine · doi:10.25259/ijnm_26_24
Martinello, C., Iacovitti, C. M., Marin, A., Tasevski, S., Rizzo, A., Cuzzocrea, M., Paone, G., Albano, D., & Treglia, G. (2026) · Frontiers in Oncology · doi:10.3389/fonc.2026.1872033
Asakly, M., Sharabi‐Nov, A., Barazani-Avitan, M., Gantus, J., Khalaila, A., Darawshi, H., Shehadeh, R., Simon, A. B., Avraham, Y., Edelstein, M., et al. (2026) · Diagnostics · doi:10.3390/diagnostics16142231
Kitamura, T., Kawaguchi, N., Matsuoka, M., MATSUMOTO, K., Yakata, H., Okada, T., Miyagawa, M., & Kido, T. (2026) · Annals of Nuclear Medicine · doi:10.1007/s12149-026-02264-3
- Authors
- Pencharz, D., Nathan, M., & Wagner, T. L.
- Affiliations
- Brighton and Sussex University Hospitals NHS Trust (GB)
- Royal Free London NHS Foundation Trust (GB)
- Venue
- The British Journal of Radiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-01-31
- Volume
- 91
- Issue
- 1084
- Pages
- 20170774-20170774
- ISSN
- 0007-1285 (ISSN-L)
- 1748-880X
- PMC
- PMC5965993
- OpenAlex
- W2775337940
- Cited by
- 42
- References
- 92
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 7 · 2023: 6 · 2022: 5 · 2021: 9 · 2020: 4 · 2019: 3 · 2018: 1 · 2015: 1
- FWCI
- 1.68
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- British Journal of Radiology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiology practices and education
- Keywords
- 18F-FDG PET/CT, standardized uptake value, SUVmax, malignancy incidence, differential diagnosis, pituitary gland, thyroid gland, breast, lung parenchyma, colon, adrenal gland, prostate, parotid gland, nasopharynx, esophagus, pancreas, uterus, ovary, cancer risk stratification, follow-up management
- MeSH terms
- Positron Emission Tomography Computed Tomography, Diagnosis, Differential, Humans, Tissue Distribution, Radiopharmaceuticals, Evidence-Based Medicine, Fluorodeoxyglucose F18, Incidental Findings
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