Spectrum of PET-CT pelvic pitfalls in patients with gynecologic malignancies

Integrated positron emission tomography-computed tomography (PET-CT) represents a major technologic advance in oncologic imaging of patients with gynecologic malignancies, since it improves localization of regions of increased 18F-fluorodeoxyglucose (FDG) uptake and staging/restaging accuracy by allowing a near-simultaneous acquisition of co-registered, spatially matched metabolic and anatomic data in the same examination. However, physiologic processes, normal variants, and many benign lesions within the pelvis can accumulate FDG and may be confused with malignant neoplasms. Conversely, false-negative results due to malignancies with low FDG uptake can pose a diagnostic challenge in patients with gynecologic cancer. With the increased use of PET-CT in patients with gynecologic malignancies, misinterpretation of these potential pitfalls can have significant implications and alter staging/restaging and patient management. In this article, we review these potential pitfalls in integrated PET-CT of the pelvis in patients with gynecologic cancer.