Skip to main content

Comparison of (18)F-FDG PET/CT and (99 m)Tc-MDP bone scintigraphy for detection of bone metastasis in osteosarcoma

Skeletal Radiology volume 42, pages 1673–1681 (2013)Cite this article

Abstract

Objective

We compared the diagnostic performance of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and (99 m)Tc-methylene diphosphonate bone scintigraphy (BS) for the detection of bone metastasis in osteosarcoma.

Materials and methods

We retrospectively reviewed 206 patients with stage II–IV osteosarcoma treated with surgery and chemotherapy as well as at least one paired PET/CT and BS scan (defined as an examination). PET/CT and BS images were interpreted separately. When analyzing the diagnostic yield of a combination of PET/CT and BS (PET/CT+BS), an examination was considered positive if either PET/CT or BS scored positive. The final diagnosis was obtained from histological findings or clinical follow-up with imaging studies for at least 6 months. Diagnostic performances of PET/CT, BS, and their combinations were calculated.

Results

Out of 833 examinations in 206 patients, 55 with 101 lesions in 38 patients were confirmed as bone metastases. The sensitivity, specificity, and diagnostic accuracy were 95, 98, and 98 %, respectively, for PET/CT; 76, 97, and 96 %, respectively, for BS; and 100, 96, and 97 %, respectively, for PET/CT+BS in an examination-based analysis. Lesion-based analysis demonstrated that the sensitivity of PET/CT+BS (100 %) was significantly higher than that of PET/CT (92 %) or BS (74 %) alone. BS detected significantly less bone metastases in the growth plate region than outside the growth plate region (22 vs. 77 %).

Conclusions

PET/CT is more sensitive and accurate than BS for diagnosing bone metastases in osteosarcoma. The combined use of PET/CT and BS improves sensitivity.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. Bacci G, Longhi A, Bertoni F, et al. Bone metastases in osteosarcoma patients treated with neoadjuvant or adjuvant chemotherapy: the Rizzoli experience in 52 patients. Acta Orthop. 2006;77:938–43.

    PubMed  Article  Google Scholar 

  2. Huth JF, Eilber FR. Patterns of recurrence after resection of osteosarcoma of the extremity. Strategies for treatment of metastases. Arch Surg. 1989;124:122–6.

    PubMed  Article  CAS  Google Scholar 

  3. Aung L, Gorlick R, Healey JH, et al. Metachronous skeletal osteosarcoma in patients treated with adjuvant and neoadjuvant chemotherapy for nonmetastatic osteosarcoma. J Clin Oncol. 2003;21:342–8.

    PubMed  Article  Google Scholar 

  4. San-Julian M, Diaz-de-Rada P, Noain E, Sierrasesumaga L. Bone metastases from osteosarcoma. Int Orthop. 2003;27:117–20.

    PubMed  CAS  Google Scholar 

  5. Meyer JS, Nadel HR, Marina N, et al. Imaging guidelines for children with Ewing sarcoma and osteosarcoma: a report from the Children’s Oncology Group Bone Tumor Committee. Pediatr Blood Cancer. 2008;51:163–70.

    PubMed  Article  Google Scholar 

  6. Franzius C, Sciuk J, Daldrup-Link HE, Jürgens H, Schober O. FDG-PET for detection of osseous metastases from malignant primary bone tumours: comparison with bone scintigraphy. Eur J Nucl Med. 2000;27:1305–11.

    PubMed  Article  CAS  Google Scholar 

  7. Cheon GJ, Kim MS, Lee JA, et al. Prediction model of chemotherapy response in osteosarcoma by 18F-FDG PET and MRI. J Nucl Med. 2009;50:1435–40.

    PubMed  Article  CAS  Google Scholar 

  8. Im HJ, Kim TS, Park SY, et al. Prediction of tumour necrosis fractions using metabolic and volumetric 18F-FDG PET/CT indices, after one course and at the completion of neoadjuvant chemotherapy, in children and young adults with osteosarcoma. Eur J Nucl Med Mol Imaging. 2012;39:39–49.

    PubMed  Article  CAS  Google Scholar 

  9. Reddick RL, Michelitch HJ, Levine AM, Triche TJ. Osteogenic sarcoma: a study of the ultrastructure. Cancer. 1980;45:64–71.

    PubMed  Article  CAS  Google Scholar 

  10. Volker T, Denecke T, Steffen I, et al. Positron emission tomography for staging of pediatric sarcoma patients: results of a prospective multicenter trial. J Clin Oncol. 2007;25:5435–41.

    PubMed  Article  Google Scholar 

  11. Walter F, Czernin J, Hall T, et al. Is there a need for dedicated bone imaging in addition to 18F-FDG PET/CT imaging in pediatric sarcoma patients? J Pediatr Hematol Oncol. 2012;34:131–6.

    PubMed  Article  CAS  Google Scholar 

  12. Hutchings M, Barrington SF. PET/CT for therapy response assessment in lymphoma. J Nucl Med. 2009;50 suppl 1:S21–30.

    Article  Google Scholar 

  13. Kong CB, Song WS, Cho WH, Oh JM, Jeon DG. Local recurrence has only a small effect on survival in high-risk extremity osteosarcoma. Clin Orthop Relat Res. 2012;470:1482–90.

    PubMed  Article  Google Scholar 

  14. Ozulker T, Kucukoz Uzun A, Ozulker F, Ozpaçac T. Comparison of (18)F-FDG-PET/CT with (99m)Tc-MDP bone scintigraphy for the detection of bone metastases in cancer patients. Nucl Med Commun. 2010;31:597–603.

    PubMed  Google Scholar 

  15. Yang KT, Yang AD. Evaluation of activity of epiphyseal plates in growing males and females. Calcif Tissue Int. 2006;78:348–56.

    PubMed  Article  CAS  Google Scholar 

  16. Harcke HT, Mandell GA. Scintigraphic evaluation of the growth plate. Semin Nucl Med. 1993;23:266–73.

    PubMed  Article  CAS  Google Scholar 

  17. Guillemart A, Le Pape A, Galy G, Besnard JC. Bone kinetics of calcium-45 and pyrophosphate labeled with technetium-96: an autoradiographic evaluation. J Nucl Med. 1980;21:466–70.

    PubMed  CAS  Google Scholar 

  18. Helyar V, Mohan HK, Barwick T, Besnard JC. The added value of multislice SPECT/CT in patients with equivocal bony metastasis from carcinoma of the prostate. Eur J Nucl Med Mol Imaging. 2010;37:706–13.

    PubMed  Article  Google Scholar 

  19. Oh JR, Byun BH, Hong SP, et al. Comparison of 131I whole-body imaging, 131I SPECT/CT, and 18F-FDG PET/CT in the detection of metastatic thyroid cancer. Eur J Nucl Med Mol Imaging. 2011;38:1459–68.

    PubMed  Article  Google Scholar 

  20. Nakai T, Okuyama C, Kubota T, et al. Pitfalls of FDG-PET for the diagnosis of osteoblastic bone metastases in patients with breast cancer. Eur J Nucl Med Mol Imaging. 2005;32:1253–8.

    PubMed  Article  Google Scholar 

  21. Abe K, Sasaki M, Kuwabara Y, et al. Comparison of 18FDG-PET with 99mTc-HMDP scintigraphy for the detection of bone metastases in patients with breast cancer. Ann Nucl Med. 2005;19:573–9.

    PubMed  Article  Google Scholar 

  22. Zaidi H, Ojha N, Morich M, et al. Design and performance evaluation of a whole-body Ingenuity TF PET-MRI system. Phys Med Biol. 2011;56:3091–106.

    PubMed  Article  CAS  Google Scholar 

  23. Pfluger T, Melzer HI, Mueller WP, et al. Diagnostic value of combined 18F-FDG PET/MRI for staging and restaging in paediatric oncology. Eur J Nucl Med Mol Imaging. 2012;39:1745–55.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

This work was supported by Establishment of Center for PET Application Technology Development, Korea Institute of Radiological and Medical Sciences (KIRAMS), and by grants from the Ministry of Education, Science and Technology (50441–2013).

Conflict of interest

The authors declare that they have no conflicts of interest.

Author information

Affiliations

  1. Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75 Nowongil, Nowon Gu, Seoul, 139-706, Republic of Korea

    Byung Hyun Byun, Ilhan Lim, Byung Il Kim, Chang Woon Choi & Sang Moo Lim

  2. Department of Orthopedic Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75 Nowongil, Nowon Gu, Seoul, Republic of Korea

    Chang-Bae Kong, Won Seok Song, Wan Hyeong Cho, Dae-Geun Jeon & Soo-Yong Lee

  3. Department of Pathology, Korea Cancer Center Hospital, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75 Nowongil, Nowon Gu, Seoul, Republic of Korea

    Jae-Soo Koh

Authors
  1. Byung Hyun Byun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chang-Bae Kong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ilhan Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Byung Il Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chang Woon Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Won Seok Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wan Hyeong Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dae-Geun Jeon
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jae-Soo Koh
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Soo-Yong Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sang Moo Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sang Moo Lim.

Electronic supplementary materials

Below is the link to the electronic supplementary material.

Supplemental Table 1

(DOCX 18 kb)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Byun, B.H., Kong, CB., Lim, I. et al. Comparison of (18)F-FDG PET/CT and (99 m)Tc-MDP bone scintigraphy for detection of bone metastasis in osteosarcoma. Skeletal Radiol 42, 1673–1681 (2013). https://doi.org/10.1007/s00256-013-1714-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-013-1714-4

Keywords

  • PET
  • Bone scan
  • Bone metastasis
  • Osteosarcoma