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Fat necrosis after abdominal surgery: A pitfall in interpretation of FDG-PET/CT

  • Oncology
  • Published:
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Abstract

Objective

We describe FDG-PET/CT findings of postoperative fat necrosis in patients following abdominal surgery, and evaluate their changes in size and FDG uptake over time.

Methods

FDG-PET/CT scans from January 2007–January 2016 containing the term ‘fat necrosis’ were reviewed. Lesions meeting radiological criteria of fat necrosis in patients with prior abdominal surgery were included.

Results

Forty-four patients, 30 males, mean age 68.4 ± 11.0 years. Surgeries: laparotomy (n=37; 84.1 %), laparoscopy (n=3; 6.8 %), unknown (n=4; 9.1 %). CTs of all lesions included hyperdense well-defined rims surrounding a heterogeneous fatty core. Sites: peritoneum (n=34; 77 %), omental fat (n=19; 43 %), subcutaneous fat (n=8; 18 %), retroperitoneum (n=2; 5 %). Mean lesion long axis: 33.6±24.9 mm (range: 13.0–140.0). Mean SUVmax: 2.6±1.1 (range: 0.6–5.1). On serial CTs (n=34), lesions decreased in size (p=0.022). Serial FDG-PET/CT (n=24) showed no significant change in FDG-avidity (p=0.110). Mean SUVmax did not correlate with time from surgery (p=0.558) or lesion size (p=0.259).

Conclusion

Postsurgical fat necrosis demonstrated characteristic CT features and may demonstrate increased FDG uptake. However, follow-up of subsequent imaging scans showed no increases in size or FDG-avidity. Awareness of this entity is important to avoid misinterpretation of findings as recurrent cancer.

Key Points

• Postsurgical fat necrosis may mimic cancer in FDG-PET/CT.

• Follow-up of fat necrosis showed no increase in FDG intensity.

• CT follow-up showed a decrease in lesion size.

• FDG uptake did not correlate with time lapsed from surgery.

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Abbreviations

CT:

Computed tomography

FDG:

Fluorodeoxyglucose

PET:

Positron emission tomography

SUV:

Standardized uptake values

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Acknowledgements

An abstract of this work has been submitted for presentation at RSNA 2017 (Radiologic Society of North America).

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Chaim Sheba Medical Center, 5265601, Tel Hashomer, Israel

    Tima Davidson, Elinor Goshen & Simona Ben-Haim

  2. Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel

    Tima Davidson, Eyal Lotan, Eyal Klang, Elinor Goshen & Sara Apter

  3. Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel

    Eyal Lotan, Eyal Klang & Sara Apter

  4. Technion – Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel

    Johnatan Nissan

  5. Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel

    Jeffrey Goldstein

  6. Institute of Nuclear Medicine, University College London and UCL Hospitals, NHS Trust, London, UK

    Simona Ben-Haim

  7. Division of Surgery, Assaf Harofeh Medical Center, Zerifin, Israel

    Bar Chikman

Authors
  1. Tima Davidson
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  2. Eyal Lotan
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  3. Eyal Klang
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  4. Johnatan Nissan
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  5. Jeffrey Goldstein
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  6. Elinor Goshen
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  7. Simona Ben-Haim
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  8. Sara Apter
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  9. Bar Chikman
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Corresponding authors

Correspondence to Tima Davidson or Johnatan Nissan.

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The scientific guarantor of this publication is Dr. Tima Davidson.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• performed at one institution

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Davidson, T., Lotan, E., Klang, E. et al. Fat necrosis after abdominal surgery: A pitfall in interpretation of FDG-PET/CT. Eur Radiol 28, 2264–2272 (2018). https://doi.org/10.1007/s00330-017-5201-5

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  • DOI: https://doi.org/10.1007/s00330-017-5201-5

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