FDG-PET and CT patterns of bone metastases and their relationship to previously administered anti-cancer therapy

  • Ora Israel
  • Anat Goldberg
  • Alicia Nachtigal
  • Daniela Militianu
  • Rachel Bar-Shalom
  • Zohar Keidar
  • Ignac Fogelman
Original article



To assess 18F-fluorodeoxyglucose (FDG) uptake in bone metastases in patients with and without previous treatment, and compare positive positron emission tomography (PET) with osteolytic or osteoblastic changes on computed tomography (CT).


One hundred and thirty-one FDG-PET/CT studies were reviewed for bone metastases. A total of 294 lesions were found in 76 patients, 81 in untreated patients and 213 in previously treated patients. PET was assessed for abnormal FDG uptake localised by PET/CT to the skeleton. CT was evaluated for bone metastases and for blastic or lytic pattern. The relationship between the presence and pattern of bone metastases on PET and CT, and prior treatment was statistically analysed using the chi-square test.


PET identified 174 (59%) metastases, while CT detected 280 (95%). FDG-avid metastases included 74/81 (91%) untreated and 100/213 (47%) treated lesions (p<0.001). On CT there were 76/81 (94%) untreated and 204/213 (96%) treated metastases (p NS). In untreated patients, 85% of lesions were seen on both PET and CT (26 blastic, 43 lytic). In treated patients, 53% of lesions were seen only on CT (95 blastic, 18 lytic). Of the osteoblastic metastases, 65/174 (37%) were PET positive and 98/120 (82%), PET negative (p<0.001).


The results of the present study indicate that when imaging bone metastases, prior treatment can alter the relationship between PET and CT findings. Most untreated bone metastases are PET positive and lytic on CT, while in previously treated patients most lesions are PET negative and blastic on CT. PET and CT therefore appear to be complementary in the assessment of bone metastases.


Bone metastases FDG PET CT Treatment 


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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Ora Israel
    • 1
    • 2
  • Anat Goldberg
    • 1
  • Alicia Nachtigal
    • 3
  • Daniela Militianu
    • 3
  • Rachel Bar-Shalom
    • 1
    • 2
  • Zohar Keidar
    • 1
    • 2
  • Ignac Fogelman
    • 4
  1. 1.Department of Nuclear MedicineRambam Health Care CampusHaifaIsrael
  2. 2.B. Rappaport School of MedicineTechnion, Israel Institute of TechnologyHaifaIsrael
  3. 3.Department of Diagnostic ImagingRambam Health Care CenterHaifaIsrael
  4. 4.Division of Imaging SciencesGuy’s, King’s and St Thomas’ School of MedicineLondonUK

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