Esophagus
The normal esophagus typically demonstrates little or no FDG uptake.
Diffuse Esophageal Uptake: Diffuse esophageal uptake is almost never neoplastic.
- Mild to Moderately Avid: Mild to moderate diffuse uptake is nearly always normal.
- Intensely Avid: Almost always reflects esophagitis.
Focal Esophageal Uptake: Focal FDG uptake in the esophagus should always raise a suspicion for malignancy, unless an explanation for the focal uptake is evident on the images (or can be explained by the clinical history).
- Moderate or intense distal esophageal uptake can reflect reflux esophagitis. Upper endoscopy may be required to exclude malignancy.
- Focal intense uptake can be secondary to radiation therapy in the region.
- Focal uptake at the lower esophageal sphincter (LES) typically represents normal physiologic muscle uptake.
Case 1
Case 1 (Image 2)
Normal fused sagittal PET/CT appearance of the esophagus, which demonstrates no appreciable uptake above mediastinal blood pool activity.
Case 1 (Image 3)
Normal fused axial appearance of the esophagus, which demonstrates no appreciable activity above mediastinal blood pool uptake.
Case 2
Case 2 (Image 2)
Fused axial and sagittal imaging confirms both the diffuse nature of this finding and the lack of an associated soft tissue abnormality.
Case 3
Case 3 (Image 2)
Fused axial and sagittal imaging confirms both the diffuse nature of this finding and the lack of an associated soft tissue abnormality. This is the typical PET/CT appearance of diffuse esophagitis.
Case 4
Case 4 (Image 2)
Fused axial and sagittal imaging confirms the diffuse nature of this finding. There is the suggestion of associated mild, diffuse esophageal wall thickening, non-focal. This is a common PET/CT appearance of diffuse esophagitis.
Case 5
Case 5 (Image 2)
MIP images in this patient with a large lung cancer demonstrate a small focus of intense FDG uptake at the gastroesophageal junction.
Case 5 (Image 3)
Axial images confirm focal intense uptake involving the distal esophagus, at the gastroesophageal junction. An associated soft tissue lesion is not identified. This is the typical appearance of physiologic uptake involving the lower esophageal sphincter. Some radiologists hedge on this finding, fearing to overlook an early/small distal esophageal cancer.
Case 6
Case 6 (Image 2)
Coronal images reveal the focal uptake (white circle) to be located along the superior margin of a hiatal hernia (red circle). This represents normal physiologic uptake involving the lower esophageal sphincter, which is located superior and to the right of its expected location, due to the patient’s hiatal hernia.
Case 7
Case 7 (Image 2)
Fused axial image confirms intense metabolic activity in a region of focal esophageal wall thickening (biopsy proven esophageal carcinoma).
Case 7 (Image 3)
CT images better illustrates the thickened esophageal wall.
Case 7 (Image 4)
Fused image demonstrates a hypermetabolic liver metastasis and an intensely avid metastatic retroperitoneal lymph node.
Case 7 (Image 5)
A hypermetabolic right hilar lymph node is present, suspicious for metastatic disease.
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