Non-malignant FDG uptake in infradiaphragmatic adipose tissue: a new site of physiological tracer biodistribution characterised by PET/CT

The purpose of this study was to characterise a benign pattern of infradiaphragmatic F-18-fluorodeoxyglucose (FDG) uptake in cancer patients using PET/CT. Infradiaphragmatic foci of FDG uptake, localised by PET/CT in regions of normal fat tissues, were demonstrated, in conjunction with fatty uptake in the neck and shoulders, in 9 of 1,241 (0.7%) patients. The imaging and clinical characteristics of this pattern and its possible clinical significance were assessed. PET/CT precisely localised infradiaphragmatic fat uptake (IDFU) within normal retroperitoneal fatty tissue of the perirenal space (nine patients) and in the paracolic or parahepatic space (four patients). Perirenal uptake was bilateral in five patients and focal in six. Paracolic and parahepatic uptake was bilateral in three patients and linear in all four patients. There was no evidence of malignancy at any of the sites during a follow-up period of 9-21 months. IDFU was significantly more prevalent in young patients assessed for monitoring response to therapy, and was always associated with the benign supradiaphragmatic uptake pattern, although its prevalence was significantly lower. There were no significant differences between the clinical characteristics of these two patterns of benign fatty FDG uptake. It is concluded that PET/CT allows for precise identification of increased FDG uptake in abdominal fatty tissue and further exclusion of disease at such sites. This benign uptake may represent increased glucose consumption in activated brown adipose tissue, similar to the mechanism suggested for supradiaphragmatic uptake. Recognition of this benign IDFU pattern is important for correct interpretation of abdominal PET findings in cancer patients.