Pitfalls and Misinterpretations of Cardiac Findings on PET/CT Imaging: A Careful Look at the Heart in Oncology Patients

Positron emission tomography (PET) computed tomography (CT) with 2-fluorine-18] fluoro-2-deoxy-d-glucose (FDG) has been established as an effective modality for evaluation of cancer. Interpretations of patterns of physiologic ¹⁸F-FDG uptake by the heart is particularly difficult given the wide normal variations of ¹⁸F-FDG metabolic activity observed. Atypical patterns of focal or diffuse physiologic cardiac ¹⁸F-FDG uptake and post-therapeutic effects after radiation therapy, systemic diseases, or cardiomyopathy may also be confused with malignant disease on ¹⁸F-FDG PET/CT. In this article, we review the variations of normal cardiac ¹⁸F-FDG uptake observed in oncology patients and the appearances of other patterns of pathologic metabolic activity, related or not related to the malignancy being investigated, that may lead to false-negative and false-positive results.