IMAGES THAT TEACH
The role of FDG uptake intensity in pericardial
Yiyan Liu, MD, PhD
Nuclear Medicine Service, Department of Radiology, New Jersey Medical School, Rutgers
University, Newark, NJ
Nuclear Medicine Service, Department of Radiology, University Hospital, Newark, NJ
Received Jul 14, 2016; accepted Jul 14, 2016
Pericardial effusion (PE) is a relatively common
clinical condition in oncologic patients. The differential
diagnosis between benign and malignant PE is difﬁcult
without pericardial ﬂuid analysis/pericardial biopsy.
The following case presentations demonstrate the role of
FDG uptake in the differential diagnosis.
Patient 1 was a 55-year-old man with a newly
diagnosed adenocarcinoma of the right lung. FDG
PET/CT was obtained for staging, which showed
moderately FDG avid PE with SUV
from pericardiocentesis was indicative of metastasis
Patient 2 was an 18-year-old man with a history
of AIDS and lymphadenopathy. FDG PET/CT was
performed for evaluation of lymphoma, which demon-
strated a mildly FDG avid PE with SUV
cytological analysis from pericardiocentesis showed
lymphocytes and other inﬂammatory cells, consistent
with pericarditis (Figure 1B).
Patient 3 was a 34-year-old man who was a newly
diagnosed mediastinal Hodgkina
s lymphoma. Staging
PET/CT showed a large PE with very mild FDG uptake
1.5). Cytological analysis from pericardiocent-
esis was negative for either malignancy or infection. PE
was assumed to be reactive (Figure 1C).
In all the cases, SUV was determined by drawing
the region of interest over the pericardial ﬂuid rather
In most of the oncologic patients, PE is secondary to
a benign etiology such as chemotherapy, chest radiation,
pericarditis, or idiopathic. FDG avid PE is not a
common ﬁnding on PET/CT imaging. Unlike anatomic
imaging modalities, FDG PET/CT has the unique ability
to identify hypermetabolic tissue including ﬂuid in the
absence of obvious abnormality of the structure. There is
no or minimal uptake of the normal pericardium on FDG
PET/CT. The absence of FDG uptake within PE is
usually indicative of a benign, nonmalignant etiology.
Visualized uptake within PE suggests a pathological
process. Although FDG is not speciﬁc for malignancy
and increased uptake is frequently seen in inﬂammation/
infection or other nonneoplastic diseases, semiquantita-
tion of uptake with SUV
can help to differentiate a
benign or inﬂammatory/infectious process from malig-
nancy or metastasis. There were very sparse case reports
about FDG PET/CT detection of pericardial metastasis
in the literature.
The cases presented here demon-
strated that SUV
might be used for the differentiation
of benign (reactive or inﬂammatory) from malignant/
metastatic origin of PE. Malignant/metastatic PE was
associated with higher FDG uptake than benign or
inﬂammatory PE on PET/CT.
Reprint requests: Yiyan Liu, MD, PhD, Nuclear Medicine Service,
Department of Radiology, University Hospital, H-14130, 150
Bergen Street, Newark, NJ 07103; firstname.lastname@example.org
J Nucl Cardiol 2017;24:1440–1.
Copyright Ó 2016 American Society of Nuclear Cardiology.