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Predominance and homogeneity patterns of physiological FDG accumulation in thoracic and lumbar vertebrae: suspected mechanism of “bone pseudometastasis” on FDG-PET in Japanese patients with esophageal cancer

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Abstract

Objective

False-positive bone lesions (bone pseudometastases) have been often reported in patients with esophageal cancer (EsoC). This study aimed to evaluate the vertebral 2-deoxy-2-[18F] fluoro-d-glucose (FDG) accumulation pattern in patients with newly diagnosed esophageal cancers and other malignancies (OtherT) to elucidate the possible mechanism that causes bone pseudometastasis.

Methods

FDG positron emission tomography/computed tomography performed for 90 patients with EsoC, and 112 patients with OtherT was retrospectively evaluated. The uptake pattern in the thoracic (Th) and lumbar (L) vertebrae was visually assessed regarding predominance (TL, Th ≒ L; Td, Th > L; Ld, L > Th), main intensity compared with the uptake in the blood pool (BP) (Grade 1 < BP, Grade 2 ≒ BP, or Grade 3 > BP), and homogeneity (homogeneous, heterogeneous, marginal, or spotty). The patterns between EsoC and OtherT and between Th and L were compared.

Results

TL, Td, and Ld patterns were observed in 51.1%, 48.9%, and 0% in EsoC and 79.7%, 20.3%, and 0% in OtherT. Though Grade 2 was most frequently observed in both groups, the ratio of Grade 3 in Th and Grade 1 in L was significantly higher in EsoC than in OtherT. Heterogeneous and spotty patterns were more frequently observed in L and in EsoC, and these were strongly associated with Td pattern.

Conclusion

Td pattern was frequently seen, especially in EsoC, and was strongly associated with a heterogeneous or marginal pattern in the L. Heterogeneous marrow distribution with declined lumbar uptake is suspected as the mechanism of bone pseudometastasis.

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Authors and Affiliations

  1. Division of PET Imaging, Shiga Medical Center Research Institute, 5-4-30, Moriyama-cho, Moriyama, 524-8524, Japan

    Chio Okuyama, Masaaki Takahashi, Kuninori Kusano, Shinya Kagawa & Hiroshi Yamauchi

  2. Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan

    Tatsuya Higashi

  3. Department of Diagnostic Radiology, Shiga General Hospital, 5-4-30, Moriyama-cho, Moriyama, 524-8524, Japan

    Ryusuke Nakamoto

  4. Human Health Sciences, Graduate School of Medicine, Kyoto University, Yoshida Konoemachi, Sakyo-ku, Kyoto, 606-8303, Japan

    Koichi Ishizu

  5. Department of Advanced Medical Imaging Research, Graduate School of Medicine, Kyoto University, Yoshida Konoemachi, Sakyo-ku, Kyoto, 606-8303, Japan

    Tsuneo Saga

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  1. Chio Okuyama
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  2. Tatsuya Higashi
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  3. Ryusuke Nakamoto
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Correspondence to Chio Okuyama.

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Okuyama, C., Higashi, T., Nakamoto, R. et al. Predominance and homogeneity patterns of physiological FDG accumulation in thoracic and lumbar vertebrae: suspected mechanism of “bone pseudometastasis” on FDG-PET in Japanese patients with esophageal cancer. Ann Nucl Med 34, 182–191 (2020). https://doi.org/10.1007/s12149-019-01430-0

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  • DOI: https://doi.org/10.1007/s12149-019-01430-0

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