Stomach
Normal intense gastric uptake is probably the most over-called “abnormality” by the inexperienced PET/CT reader.
Normal FDG uptake involving the stomach can be extremely variable. It is not uncommon to see diffuse intense uptake throughout the entire stomach or intense uptake limited to only a segment of the stomach (often the gastric fundus and/or body).
Intense uptake limited to the distal antrum has a greater likelihood of malignancy than more proximal uptake, but still typically represents normal physiologic uptake.
To properly distend the gastric lumen for adequate interpretation, we ask our patients to drink 12-ounces of water just before they recline on the imaging bed.
A suspicion for malignancy should be raised if:
- Regional uptake is accompanied by at least the suggestion of associated wall thickening; or
- Uptake is extremely focal (more likely to represent malignancy or ulcer).
Hiatal Hernia:
Hiatal hernias are frequently FDG-avid. This uptake is nearly always physiologic in nature, although inflammation associated with reflux can also result in increased metabolic activity.
Neoplasm should only be considered if there is an associated soft tissue lesion on the CT images or if the FDG uptake is limited to only a very focal segment of the soft tissue.
