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The additional value of CT images interpretation in the differential diagnosis of benign vs. malignant primary bone lesions with 18F-FDG-PET/CT

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Objective

To evaluate the value of a dedicated interpretation of the CT images in the differential diagnosis of benign vs. malignant primary bone lesions with 18fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT).

Materials and methods

In 50 consecutive patients (21 women, 29 men, mean age 36.9, age range 11–72) with suspected primary bone neoplasm conventional radiographs and 18F-FDG-PET/CT were performed. Differentiation of benign and malignant lesions was separately performed on conventional radiographs, PET alone (PET), and PET/CT with specific evaluation of the CT part. Histology served as the standard of reference in 46 cases, clinical, and imaging follow-up in four cases.

Results

According to the standard of reference, conventional 17 lesions were benign and 33 malignant. Sensitivity, specificity, and accuracy in assessment of malignancy was 85%, 65% and 78% for conventional radiographs, 85%, 35% and 68% for PET alone and 91%, 77% and 86% for combined PET/CT. Median SUVmax was 3.5 for benign lesions (range 1.6–8.0) and 5.7 (range 0.8–41.7) for malignant lesions.

In eight patients with bone lesions with high FDG-uptake (SUVmax ≥ 2.5) dedicated CT interpretation led to the correct diagnosis of a benign lesion (three fibrous dysplasias, two osteomyelitis, one aneurysmatic bone cyst, one fibrous cortical defect, 1 phosphaturic mesenchymal tumor). In four patients with lesions with low FDG-uptake (SUVmax < 2.5) dedicated CT interpretation led to the correct diagnosis of a malignant lesion (three chondrosarcomas and one leiomyosarcoma). Combined PET/CT was significantly more accurate in the differentiation of benign and malignant lesions than PET alone (p = .039). There was no significant difference between PET/CT and conventional radiographs (p = .625).

Conclusion

Dedicated interpretation of the CT part significantly improved the performance of FDG-PET/CT in differentiation of benign and malignant primary bone lesions compared to PET alone. PET/CT more commonly differentiated benign from malignant primary bone lesions compared with conventional radiographs, but this difference was not significant.

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Authors and Affiliations

  1. Division of Nuclear Medicine, Department of Medical Radiology, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland

    K. Strobel, K. D. M. Stumpe, T. F. Hany, K. Mende, P. Veit-Haibach & G. K. von Schulthess

  2. Department of Orthopedic Surgery, University Hospital Balgrist, Zurich, Switzerland

    U. E. Exner

  3. Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland

    B. Bode

  4. Department of Radiology, University Hospital Balgrist, Zurich, Switzerland

    Juerg Hodler

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  1. K. Strobel
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Strobel, K., Exner, U.E., Stumpe, K.D.M. et al. The additional value of CT images interpretation in the differential diagnosis of benign vs. malignant primary bone lesions with 18F-FDG-PET/CT. Eur J Nucl Med Mol Imaging 35, 2000–2008 (2008). https://doi.org/10.1007/s00259-008-0876-0

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  • DOI: https://doi.org/10.1007/s00259-008-0876-0

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