Other - 55 year old female

History
55 year old with remote history of breast cancer and recently diagnosed cirrhosis on ultrasound exam.

Dosage
12.16 mCi F-18 FDG by IV.

PET/CT Findings
There is inhomogeneous FDG uptake throughout the liver, which is most likely related to cirrhosis. No focal areas of intense increased FDG uptake are seen within the liver to suggest focal FDG-avid malignancy. No other areas of abnormal increased FDG uptake are seen within the neck, chest, abdomen, or pelvis.

Differential Diagnosis
Cirrhosis
Psuedocirrhosis

Pathology Report
Diffuse infiltration of the liver by metastatic carcinoma of probable breast origin, with extensive fibrotic reaction. Expert consensus of the group was that it is most likely that the fibrosis seen in this patient' s liver is entirely a desmoplastic response to the invading metastatic carcinoma.

Treatment/Follow up
This patient rapidly decompensated from esophageal varices secondary to the pseudocirrhosis approximately 2 weeks after her PET/CT scan and eventually passed away.
Discussion/References
This case demonstrates one of the limitations of PET/CT, which is really a limitation of FDG; that is that some tumors are not intensely FDG avid. Although this liver was filled with metastatic lesions, the uptake within the liver was slightly above background. Given the cirrhotic appearance, the nuclear medicine physician attributed the slight increase in the FDG uptake to be due to cirrhosis alone. Interestingly, the radiologist who later reviewed the case correctly made the diagnosis of pseudocirrhosis.