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Dear Prof. Viroj,
Thank you very much for showing your interest in our paper on F-18 fluorodeoxyglucose (F-18-FDG) positron emission tomography (PET)/computed tomography (CT) in the detection of recurrence carcinoma cervix.[1] I fully agree with your views that interpretation of PET/CT data with relation to the history, clinical features and investigative findings can never underestimate while reporting. However, with regard to false positive results due to atherosclerotic plaque, Hanif et al.[2] did not made use of hybrid imaging (PET/CT). Data were interpreted using only the PET images, hence probably the false positive. A hybrid imaging enables correct fusion of data from two modalities performed sequentially in a single session. CT attenuation correction or respiratory motion may create reconstruction artifacts leading to false positive F-18-FDG uptake. A correctly fused PET/CT helps not only in attenuation correction, but also in proper localization thus reducing the chances of false positive.
False positive FDG avid lymphadenopathy due to infectious etiologies[3] is a well-known fact. It applies to all malignancies irrespective of the site of primary. However, A follow-up PET/CT imaging or if needed histopathological correlation can be done. Even in our study, we had four false positive cases of which two patient with suspected local recurrence and lung metastasis had normal study on follow-up scan. In another two cases showed inflammatory pathology on histopathological examination. PET/CT helps the treating doctor to be more vigilant on such lymph nodes.