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Figure 2a. Contraction-induced FDG uptake in a 50-year-old woman with advanced non-small cell lung cancer who was referred for presurgical evaluation. (a) Axial FDG PET scans demonstrate multiple hypermetabolic foci in the anterior cervical region. Intense symmetric and superficial uptake in the anterior neck (arrowheads) suggests tense sternocleidomastoid muscle uptake. An additional asymmetric focus of uptake posterior to the right sternocleidomastoid muscle (arrows) suggests cervical lymph node metastasis, which represents a more advanced disease stage and renders the patient ineligible for surgery until after neoadjuvant chemotherapy. (b, c) Axial CT (b) and PET-CT fusion (c) images demonstrate that the unilateral uptake in the right cervical region corresponds to the anterior scalene muscle (long arrow) and that the superficially located symmetric FDG uptake corresponds to the sternocleidomastoid muscles (short arrows). Evaluation with PET-CT excluded the possibility of a false-positive finding (ie, metastatic disease in the neck), which would subject the patient to unnecessary chemotherapy.
