Clinical Significance of Incidental Focal 18F-FDG Uptake in the Spinal Cord of Patients with Cancer
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We investigated the incidence, location, and clinical significance of focal 18F-FDG uptake of the spinal cord in patients with cancer.
We reviewed the medical records of 22,937 consecutive adult patients with known or suspicious malignancy who underwent 18F-FDG PET/CT. PET/CT scans with incidental focal spinal cord uptake were selected and retrospectively reviewed to determine the presence, location, number, and maximum standardized uptake value (SUVmax) of any focal hypermetabolic lesions of the spinal cord. In subjects with focal spinal uptake, clinical characteristics and clinical follow-up results, including follow-up PET/CT, were reviewed.
Incidental focal spinal cord uptake was observed in 69 of 22,937 adult patients (incidence = 0.3%; M:F = 31:38; age, 55.8 ± 14.7 years). Seventy-eight focal hypermetabolic lesions on spinal cord in the PET/CT scans of the 69 study subjects were analyzed. The most common sites of focal spinal cord uptake were the T12 vertebra (47/78; 60.3%) and L1 vertebra (20/78; 25.6%). Multifocal cord uptake was found in 8 of 69 patients (11.6%). The average SUVmax for cord uptake was 2.5 ± 0.5 (range, 1.4∼3.9). There was no clinical or imaging evidence of abnormalities in the spinal cord, both at the time of PET/CT and during clinical follow-up.
Although incidental focal 18F-FDG uptake of the spinal cord is rare in patients with cancer, it may be physiological or benign, but it should not be considered as malignant involvement. Common sites for the uptake were in the T12 and L1 spine levels.
KeywordsSpinal cord 18F-FDG PET/CT Cancer Differential diagnosis
Positron emission tomography/computed tomography
Intramedullary spinal cord metastases
Standardized uptake value
Compliance with Ethical Standards
Conflicts of Interest
Chae Hong Lim, Seung Hyup Hyun, Seung Hwan Moon, Young Seok Cho, Yearn Seong Choe, Kyung-Han Lee, Byung-Tae Kim, and Joon Young Choi declare that they have no conflicts of interest related to this manuscript.
This study was performed in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
The institutional review board at our institute approved this retrospective study, and the requirement to obtain informed consent was waived.