FDG PET/CT imaging in primary osseous and soft tissue sarcomas: a retrospective review of 212 cases

  • Mathieu Charest
  • Marc Hickeson
  • Robert Lisbona
  • Javier-A. Novales-Diaz
  • Vilma Derbekyan
  • Robert E. Turcotte
Original Article



The aims of this study are to evaluate the sensitivity of FDG PET/CT for detection of soft tissue and osseous sarcomas on the basis of FDG avidity.


We retrospectively evaluated 212 consecutive patients with known soft tissue or osseous sarcoma who had undergone a FDG PET/CT study for the initial staging or assessment of recurrence of disease. The maximum standardized uptake value (SUVmax) of each primary and/or most intense metastatic lesion was measured and compared with the histological data provided in the final pathological reports. An SUVmax of 2.5 or greater was considered positive for our analysis.


Sufficient histopathological data were available for 160 soft tissue sarcomas and 52 osseous sarcomas. FDG PET/CT detected 93.9% of all sarcomas with a sensitivity of 93.7% for soft tissue sarcomas and 94.6% for osseous sarcomas. The sensitivities of the most common sarcoma histologies were 100% for leiomyosarcomas, 94.7% for osteosarcomas, 100% for Ewing’s sarcomas, 88.9% for liposarcomas, 80.0% for synovial sarcomas, 100% for gastrointestinal stromal tumors, 87.5% for malignant peripheral nerve sheath tumors, 100% for fibroblastic and myoblastic sarcomas, and 100% for malignant fibrohistiocytic tumors. The receiver-operating characteristic curve revealed an area under the curve of 94% for the discrimination of low-grade and high-grade sarcomas imaged for initial staging by FDG PET/CT.


The combined metabolic and morphological information of FDG PET/CT imaging allows high sensitivity for the detection of various sarcomas and accurate discrimination between newly diagnosed low-grade and high-grade sarcomas.


Sarcomas FDG PET/CT Grade 


  1. 1.
    American Cancer Society. Cancer facts and figures 2008. Atlanta: American Cancer Society. 2008. http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf. Accessed 10 May 2009.
  2. 2.
    Brenner W, Bohuslavizki KH, Eary JF. PET imaging of osteosarcoma. J Nucl Med 2003;44:930–42.PubMedGoogle Scholar
  3. 3.
    Hellwig D, Graeter TP, Ukena D, Groeschel A, Sybrecht GW, Schaefers HJ, et al. 18F-FDG PET for mediastinal staging of lung cancer: which SUV threshold makes sense? J Nucl Med 2007;48:1761–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Knight SB, Delbeke D, Stewart JR, Sandler MP. Evaluation of pulmonary lesions with FDG-PET. Comparison of findings in patients with and without a history of prior malignancy. Chest 1996;109:982–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Ho CL, Dehdashti F, Griffeth LK, Buse PE, Balfe DM, Siegel BA. FDG-PET evaluation of indeterminate pancreatic masses. J Comput Assist Tomogr 1996;20:363–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Eng J. ROC analysis. In: Web-based calculator for ROC curves. Baltimore: Johns Hopkins University. 2006. http://www.jrocfit.org. Accessed 28 Feb 2009.
  7. 7.
    Brisse H, Ollivier L, Edeline V, Pacquement H, Michon J, Glorion C, et al. Imaging of malignant tumours of the long bones in children: monitoring response to neoadjuvant chemotherapy and preoperative assessment. Pediatr Radiol 2004;34:595–605.CrossRefPubMedGoogle Scholar
  8. 8.
    Ioannidis JP, Lau J. 18F-FDG PET for the diagnosis and grading of soft-tissue sarcoma: a meta-analysis. J Nucl Med 2003;44:717–24.PubMedGoogle Scholar
  9. 9.
    Schulte M, Brecht-Krauss D, Heymer B, Guhlmann A, Hartwig E, Sarkar MR, et al. Grading of tumors and tumorlike lesions of bone: evaluation by FDG PET. J Nucl Med 2000;41:1695–701.PubMedGoogle Scholar
  10. 10.
    Jadvar H, Gamie S, Ramanna L, Conti PS. Musculoskeletal system. Semin Nucl Med 2004;34:254–61.CrossRefPubMedGoogle Scholar
  11. 11.
    Bastiaannet E, Groen H, Jager PL, Cobben DC, van der Graaf WT, Vaalburg W, et al. The value of FDG-PET in the detection, grading and response to therapy of soft tissue and bone sarcomas; a systematic review and meta-analysis. Cancer Treat Rev 2004;30:83–101.CrossRefPubMedGoogle Scholar
  12. 12.
    Israel-Mardirosian N, Adler LP. Positron emission tomography of soft tissue sarcomas. Curr Opin Oncol 2003;15:327–30.CrossRefPubMedGoogle Scholar
  13. 13.
    Folpe AL, Lyles RH, Sprouse JT, Conrad EU 3rd, Eary JF. (F-18) fluorodeoxyglucose positron emission tomography as a predictor of pathologic grade and other prognostic variables in bone and soft tissue sarcoma. Clin Cancer Res 2000;6:1279–87.PubMedGoogle Scholar
  14. 14.
    Sugawara Y, Zasadny KR, Neuhoff AW, Wahl RL. Reevaluation of the standardized uptake value for FDG: variations with body weight and methods for correction. Radiology 1999;213:521–5.PubMedGoogle Scholar
  15. 15.
    Schwarzbach MH, Hinz U, Dimitrakopoulou-Strauss A, Willeke F, Cardona S, Mechtersheimer G, et al. Prognostic significance of preoperative [18-F] fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging in patients with resectable soft tissue sarcomas. Ann Surg 2005;241:286–94.CrossRefPubMedGoogle Scholar
  16. 16.
    Schwarzbach MH, Dimitrakopoulou-Strauss A, Willeke F, Hinz U, Strauss LG, Zhang YM, et al. Clinical value of [18-F]] fluorodeoxyglucose positron emission tomography imaging in soft tissue sarcomas. Ann Surg 2000;231:380–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Brenner W, Conrad EU, Eary JF. FDG PET imaging for grading and prediction of outcome in chondrosarcoma patients. Eur J Nucl Med Mol Imaging 2004;31:189–95.CrossRefPubMedGoogle Scholar
  18. 18.
    Eary JF, O'Sullivan F, Powitan Y, Chandhury KR, Vernon C, Bruckner JD, et al. Sarcoma tumor FDG uptake measured by PET and patient outcome: a retrospective analysis. Eur J Nucl Med Mol Imaging 2002;29:1149–54.CrossRefPubMedGoogle Scholar
  19. 19.
    Hain SF, O’Doherty MJ, Bingham J, Chinyama C, Smith MA. Can FDG PET be used to successfully direct preoperative biopsy of soft tissue tumours? Nucl Med Commun 2003;24:1139–43.CrossRefPubMedGoogle Scholar
  20. 20.
    Endo K, Oriuchi N, Higuchi T, Iida Y, Hanaoka H, Miyakubo M, et al. PET and PET/CT using 18F-FDG in the diagnosis and management of cancer patients. Int J Clin Oncol 2006;11:286–96.CrossRefPubMedGoogle Scholar
  21. 21.
    Iagaru A, Chawla S, Menendez L, Conti PS. 18F-FDG PET and PET/CT for detection of pulmonary metastases from musculoskeletal sarcomas. Nucl Med Commun 2006;27:795–802.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Mathieu Charest
    • 1
  • Marc Hickeson
    • 2
  • Robert Lisbona
    • 2
  • Javier-A. Novales-Diaz
    • 2
  • Vilma Derbekyan
    • 2
  • Robert E. Turcotte
    • 3
  1. 1.Service of Nuclear MedicineLakeshore General HospitalPointe-ClaireCanada
  2. 2.Department of Nuclear MedicineMcGill University Health CenterMontrealCanada
  3. 3.Department of Orthopedic SurgeryMcGill University Health CenterMontrealCanada

Personalised recommendations