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Chordoma: 18F-FDG PET/CT and MRI imaging features

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Abstract

Objective

Examine the 18F-FDG PET/CT and MRI imaging characteristics of chordoma.

Materials and methods

Biopsy-proven chordoma with a pre-therapy 18F-FDG PET/CT from 2001 through 2019 in patients > 18 years old were retrospectively reviewed. Multiple PET/CT and MRI imaging parameters were assessed.

Results

A total of 23 chordoma patients were included (16 M, 7 F; average age of 60.1 ± 13.0 years) with comparative MRI available in 22 cases. This included 13 sacrococcygeal, 9 mobile spine, and one clival lesions. On 18F-FDG PET/CT, chordomas demonstrated an average SUVmax of 5.8 ± 3.7, average metabolic tumor volume (MTV) of 160.2 ± 263.8 cm3, and average total lesion glycolysis (TLG) of 542.6 ± 1210 g. All demonstrated heterogeneous FDG activity. On MRI, chordomas were predominantly T2 hyperintense (22/22) and T1 isointense (18/22), contained small foci of T1 hyperintensity (17/22), and demonstrated heterogeneous enhancement (14/20). There were no statistically significant associations found between 18F-FDG PET/CT and MRI imaging features. There was no relationship of SUVmax (p = 0.53), MTV (p = 0.47), TLG (p = 0.48), maximal dimension (p = 0.92), or volume (p = 0.45) to the development of recurrent or metastatic disease which occurred in 6/22 patients over a mean follow-up duration of 4.1 ± 2.0 years.

Conclusion

On 18F-FDG PET/CT imaging, chordomas demonstrate moderate, heterogeneous FDG uptake. Predominant T2 hyperintensity and small foci of internal increased T1 signal are common on MRI. The inherent FDG avidity of chordomas suggests that 18F-FDG PET/CT may be a useful modality for staging, evaluating treatment response, and assessing for recurrent or metastatic disease.

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Author information

Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW, Rochester, MN, 55905, USA

    Joshua T. Olson, Doris E. Wenger & Stephen M. Broski

  2. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    Peter S. Rose

  3. Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA

    Ivy A. Petersen

Authors
  1. Joshua T. Olson
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  2. Doris E. Wenger
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  3. Peter S. Rose
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  4. Ivy A. Petersen
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  5. Stephen M. Broski
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Corresponding author

Correspondence to Stephen M. Broski.

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Olson, J.T., Wenger, D.E., Rose, P.S. et al. Chordoma: 18F-FDG PET/CT and MRI imaging features. Skeletal Radiol 50, 1657–1666 (2021). https://doi.org/10.1007/s00256-021-03723-w

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  • DOI: https://doi.org/10.1007/s00256-021-03723-w

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