Arterial Injection of FDG

Inadvertent injection of FDG into the brachial artery instead of the antecubital vein results in extremely intense FDG uptake extending distally from the antecubital fossa to the ipsilateral hand, often called the “forearm/hand/glove sign”.

Instead of the antecubital vein bringing the FDG away from the arm toward the central circulation, the brachial artery delivers the FDG to the hand, resulting in extensive muscle uptake.  

In the case of an arterial injection, SUV values on the exam may be underestimated due to decreased circulating FDG resulting from extensive uptake of the injected dose in the musculature of the forearm and hand (“Sponge Effect”, described here). 

For this reason, we recommend a cautionary note at the beginning of the report:

“NOTE: Intense uptake in the left forearm and hand strongly suggests an arterial injection of FDG. In such cases, the reported SUV calculations may be underestimated.”