Intramuscular metastases on FDG PET-CT: a review of the literature

Objective Intramuscular metastases (IM) are both rare and difficult to detect using routine anatomical computed tomography (CT) imaging. However, since the introduction of F-18-fluoro-deoxy-glucose (FOG) PET-CT, the number of detected IM has increased. We review the available literature to illustrate the relevance of these findings for staging and patient management. Methods In a review of the literature, we found one series and 33 case reports of IM shown on FDG PET-CT. No cases were reported before 2005. Furthermore, we present a patient with nonsmall cell lung cancer and a solitary distant metastasis in the left musculus infraspinatus that was not detected on diagnostic CT, but was found on FDG PET-CT. Results For a total of 39 recorded cases of IM, we found that FDG PET-CT had a significant impact on patient management in at least 51% of cases. Where reported, lesions were either isodense or hypodense on CT compared with the surrounding muscle tissue. The lesions that were also analyzed with MRI showed heterogeneous intensity. Five out of 39 patients had metastases in the extraocular muscles of one or both orbits. Conclusion FOG PET-CT appears to be a sensitive tool for detecting IM, with important impact on management in many cases. Nucl Med Commun 33:117-120 (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins