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Clinical overview of the current state and future applications of positron emission tomography in bone and soft tissue sarcoma

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Abstract

Purpose

Positron emission tomography (PET) provides a noninvasive, functional assessment providing incremental diagnostic value over magnetic resonance imaging (MRI) and computed tomography (CT) for the initial staging, restaging, response assessment, and prognosis of bone and soft tissue sarcomas. The purpose of this article is to review the current state and future applications of PET in sarcoma imaging, including the clinical roles of 18F-fluorodeoxyglucose (FDG) and other PET radiotracers as well as the use of PET with concurrent MRI.

Methods

A PubMed search using the query “(‘positron emission tomography’ OR PET) AND (‘CT’ OR ‘computed tomograph*’ OR ‘MR*’ OR ‘magnetic resonance’) AND (FDG OR hypox* OR prolif*) AND sarcoma*” for PET examinations involving bone and soft tissue sarcoma studies up to February 1, 2017 were performed. Additionally, analogous Google Scholar, Scopus, and Web of Science search queries were also performed. Subsequently, references for the retrieved articles were reviewed, and the relevant publications on the subject were also included.

Discussion

A total of 30 studies were included in the review. FDG-PET with concurrent computed tomography (CT) can provide incremental diagnostic value relative to MRI to provide additional insight into the grading, staging, restaging, and response assessment in sarcomas, particularly when neoadjuvant therapy is an option. FDG-PET/CT can be used for noninvasive prediction of tumor grade and assess regional heterogeneity, providing guidance for tissue sampling and reducing the risk of undergrading and understaging. In addition, early clinical studies of sarcoma PET imaging using hypoxia and cellular proliferation agents suggest incremental diagnostic benefit over FDG-PET. The use of PET/MRI is under active investigation and may yield additional clinically impactful findings over PET/CT.

Conclusion

PET imaging used with concurrent CT or MRI provides a unique noninvasive way to assess regional biological and biochemical features for bone and soft tissue sarcomas.

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  1. Department of Radiology, Perelman School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St., 1 Silverstein, Philadelphia, PA, 19104, USA

    Po-Hao Chen, David A. Mankoff & Ronnie A. Sebro

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  1. Po-Hao Chen
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P-HC: literature search and review, and manuscript writing and editing. DAM: content planning, manuscript editing, and literature review. RAS: content planning, manuscript editing, and literature review.

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Chen, PH., Mankoff, D.A. & Sebro, R.A. Clinical overview of the current state and future applications of positron emission tomography in bone and soft tissue sarcoma. Clin Transl Imaging 5, 343–358 (2017). https://doi.org/10.1007/s40336-017-0236-9

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