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18FDG PET scanning of benign and malignant musculoskeletal lesions

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Abstract

Objective

To describe the technique, applications and advantages of 18FDG PET scanning in detection, analysis and management of musculoskeletal lesions.

Design and patients

Forty-five patients (19 males,26 females) aged 9 to 81 years had radiographs, routine radionuclide scans, CT and/or MRI of clinically suspected active benign or malignant musculoskeletal lesions. 18FDG scans with a Siemens ECAT EXACT 921 dedicated PET unit (Knoxville, Tenn.) and FWH=6 mm images acquired as a 5–6 bed examination (6 min emission and 4 min transmission) used OSEM iterative reconstruction with segmented transmission attenuation correction and a Gaussian filter (cutoff 6.7 mm). Region of interest (ROI) 3×3 pixel image analysis based on transverse whole body images (slice thickness 3.37 mm) generated Maximum Standard Uptake Values (Max SUV) with a cutoff of 2.0 used to distinguish benign and malignant lesions.

Results

Thirty-nine studies were available for SUV ROI analysis. Overall sensitivity for differentiating malignant from benign osseous and non-osseous lesions was 91.7% (22/24), overall specificity was 100% (11/11) with an accuracy of 91.7%. All aggressive lesions had a Max SUV >2.0. Data separating benign from malignant lesions and aggressive from benign lesions were statistically significant (P<0.001) in both categories. There was no statistically significant difference in distinguishing aggressive from malignant lesions (P, ns).

Conclusion

18FDG PET contributes unique information regarding metabolism of musculoskeletal lesions. By supplying a physiologic basis for more informed treatment and management, it influences prognosis and survival. Moreover, since residual, recurrent or metastatic tumors can be simultaneously documented on a single whole body scan, PET may theoretically prove to be cost-effective.

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Authors and Affiliations

  1. Columbia University College of Physicians and Surgeons, New York, N.Y., USA

    Frieda Feldman & Ronald van Heertum

  2. New York Presbyterian Hospital, New York, N.Y., USA

    Frieda Feldman, Ronald van Heertum & Chitra Manos

Authors
  1. Frieda Feldman
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  2. Ronald van Heertum
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  3. Chitra Manos
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Correspondence to Frieda Feldman.

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Feldman, F., van Heertum, R. & Manos, C. 18FDG PET scanning of benign and malignant musculoskeletal lesions. Skeletal Radiol 32, 201–208 (2003). https://doi.org/10.1007/s00256-003-0623-3

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  • DOI: https://doi.org/10.1007/s00256-003-0623-3

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