Scientific Article

Skeletal Radiology

, Volume 38, Issue 5, pp 451-458

First online:

Dual-time point PET/CT with F-18 FDG for the differentiation of malignant and benign bone lesions

  • Rong TianAffiliated withDepartment of Nuclear Medicine, West China Hospital of Sichuan University
  • , Minggang SuAffiliated withDepartment of Nuclear Medicine, West China Hospital of Sichuan University
  • , Ye TianAffiliated withDepartment of Nuclear Medicine, West China Hospital of Sichuan University
  • , Fanglan LiAffiliated withDepartment of Nuclear Medicine, West China Hospital of Sichuan University
  • , Lin LiAffiliated withDepartment of Nuclear Medicine, West China Hospital of Sichuan University
  • , Anren KuangAffiliated withDepartment of Nuclear Medicine, West China Hospital of Sichuan University
  • , Jiancheng ZengAffiliated withDepartment of Orthopaedics, West China Hospital of Sichuan University Email author 

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Abstract

Purpose

The purpose of the present study was to evaluate whether 2-fluoro[fluorine-18]-2-deoxy-d-glucose (F-18 FDG) positron emission tomography (PET) could differentiate malignant and benign bone lesions and whether obtaining delayed F-18 FDG PET images could improve the accuracy of the technique.

Methods

In a prospective study, 67 patients with bone lesions detected by computed tomography (CT) or magnetic resonance imaging were included. Whole body PET/CT imaging was performed at 1 h (early) after the F-18 FDG injection and delayed imaging at 2 h post injection was performed only in the abnormal region. Semiquantitative analysis was performed using maximum standardized uptake value (SUVmax), obtained from early and delayed images (SUVmaxE and SUVmaxD, respectively). The retention index (RI) was calculated according to the equation: RI = (SUVmaxD − SUVmaxE) × 100/SUVmaxE. Histopathology of surgical specimens and follow-up data were used as reference criteria. The SUVmaxE and RI were compared between benign and malignant lesions.

Results

The final diagnoses revealed 53 malignant bone lesions in 37 patients and 45 benign lesions in 30 patients. There were statistically significant differences in the SUVmaxE between the malignant and benign lesions (P = 0.03). The mean SUVmaxE was 6.8 ± 4.7 for malignant lesions and 4.5 ± 3.3 for benign lesions. However, a considerable overlap in the SUVmaxE was observed between some benign and malignant tumors. With a cutoff value of 2.5 for the SUVmaxE, the sensitivity, specificity, and accuracy were 96.0%, 44.0%, and 72.4%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) were 67.1% and 90.9%, respectively. There were significant differences in the RI between the malignant and benign lesions (P = 0.004). But there was overlap between the two groups. The mean RI was 7 ± 11 for the benign lesions and 18 ± 11 for the malignant lesions. When an RI of 10 was used as the cutoff point, the sensitivity, specificity, and accuracy were 90.6%, 76.0%, and 83.7.0%, respectively. The PPV and NPV were 81.4% and 87.1%, respectively.

Conclusions

The results of this study indicate that dual-time point F-18 FDG PET may provide more help in the differentiation of malignant tumors from benign ones.

Keywords

F-18 FDG PET Bone lesion SUVmax Dual-time point