PET/CT in Benign and Malignant Musculoskeletal Tumors and Tumor-Like Conditions

Yun Young Choi; Ji Young Kim; Seoung-Oh Yang

doi:10.1055/s-0034-1371016

Seminars in Musculoskeletal Radiology, Table of Contents

Semin Musculoskelet Radiol 2014; 18(02): 133-148
DOI: 10.1055/s-0034-1371016

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

PET/CT in Benign and Malignant Musculoskeletal Tumors and Tumor-Like Conditions

Authors

Yun Young Choi

¹Department of Nuclear Medicine, Hanyang University Medical Center, Seoul, Korea
Ji Young Kim

¹Department of Nuclear Medicine, Hanyang University Medical Center, Seoul, Korea
Seoung-Oh Yang

²Department of Nuclear Medicine, Asia Cancer Center(DIRAMS), Busan, Korea

Abstract

This article briefly reviews malignant bone tumors, diffuse marrow infiltrating diseases, and other benign bone diseases with fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) that should be differentiated from malignant tumors. Clinical use of FDG PET/CT in (1) primary malignant bone tumors including osteosarcoma, malignant fibrous histiocytoma, and primary bone lymphoma, (2) hematopoietic tumors with bone marrow involvement, such as plasmacytoma, multiple myeloma, lymphoma and leukemia, and (3) benign tumors and tumor-like lesions including hemangioma, neurogenic tumor, fibrous dysplasia, and nodular fasciitis are presented, with an emphasis on various imaging findings on FDG PET/CT. Benign tumors and tumor-like conditions are often incidentally detected on FDG PET/CT in serial follow-up studies of cancer patients and should be differentiated from metastasis.

Keywords

F-18 fluorodeoxyglucose - PET/CT - bone tumor - malignant - benign

Full Text

References

References
1 Resnick D, Kyriakos M, Greenway GD. Tumor and tumor-like lesions of bone: Imaging and pathology of specific lesions. In: Resnick D, Kransdorf MJ, , eds. Bone and Joint Imaging. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2005: 1120-1198
2 Davies AM. Primary bone tumors. In: Pope TL, Bloem HL, Beltran J, Morrison WB, Wilson DJ, , eds. Imaging of the Musculoskeletal System. Philadelphia, PA: Saunders Elsevier; 2008: 1679-1708
3 Bielack SS, Kempf-Bielack B, Delling G , et al. Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol 2002; 20 (3) 776-790
4 Mialou V, Philip T, Kalifa C , et al. Metastatic osteosarcoma at diagnosis: prognostic factors and long-term outcome—the French pediatric experience. Cancer 2005; 104 (5) 1100-1109
5 Peller PJ. Role of positron emission tomography/computed tomography in bone malignancies. Radiol Clin North Am 2013; 51 (5) 845-864
6 Quartuccio N, Treglia G, Salsano M , et al. The role of Fluorine-18-Fluorodeoxyglucose positron emission tomography in staging and restaging of patients with osteosarcoma. Radiol Oncol 2013; 47 (2) 97-102
7 Rakheja R, Makis W, Skamene S , et al. Correlating metabolic activity on 18F-FDG PET/CT with histopathologic characteristics of osseous and soft-tissue sarcomas: a retrospective review of 136 patients. AJR Am J Roentgenol 2012; 198 (6) 1409-1416
8 Charest M, Hickeson M, Lisbona R, Novales-Diaz JA, Derbekyan V, Turcotte RE. FDG PET/CT imaging in primary osseous and soft tissue sarcomas: a retrospective review of 212 cases. Eur J Nucl Med Mol Imaging 2009; 36 (12) 1944-1951
9 Fuglø HM, Jørgensen SM, Loft A, Hovgaard D, Petersen MM. The diagnostic and prognostic value of ¹⁸F-FDG PET/CT in the initial assessment of high-grade bone and soft tissue sarcoma. A retrospective study of 89 patients. Eur J Nucl Med Mol Imaging 2012; 39 (9) 1416-1424
10 Franzius C, Daldrup-Link HE, Sciuk J , et al. FDG-PET for detection of pulmonary metastases from malignant primary bone tumors: comparison with spiral CT. Ann Oncol 2001; 12 (4) 479-486
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 (2) 131-136
12 Byun BH, 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 2013; 42 (12) 1673-1681
13 Kong CB, Byun BH, Lim I , et al. ¹⁸F-FDG PET SUVmax as an indicator of histopathologic response after neoadjuvant chemotherapy in extremity osteosarcoma. Eur J Nucl Med Mol Imaging 2013; 40 (5) 728-736
14 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 (9) 1435-1440
15 Byun BH, Kong CB, Lim I , et al. Combination of 18F-FDG PET/CT and diffusion-weighted MR imaging as a predictor of histologic response to neoadjuvant chemotherapy: preliminary results in osteosarcoma. J Nucl Med 2013; 54 (7) 1053-1059
16 Costelloe CM, Macapinlac HA, Madewell JE , et al. 18F-FDG PET/CT as an indicator of progression-free and overall survival in osteosarcoma. J Nucl Med 2009; 50 (3) 340-347
17 Byun BH, Kong CB, Park JH , et al. Initial metabolic tumor volume measured by 18F-FDG PET/CT can predict the outcome of osteosarcoma of the extremities. J Nucl Med 2013; 54 (10) 1725-1732
18 Brenner W, Conrad EU, Eary JF. FDG PET imaging for grading and prediction of outcome in chondrosarcoma patients. Eur J Nucl Med Mol Imaging 2004; 31 (2) 189-195
19 Aoki J, Watanabe H, Shinozaki T, Tokunaga M, Inoue T, Endo K. FDG-PET in differential diagnosis and grading of chondrosarcomas. J Comput Assist Tomogr 1999; 23 (4) 603-608
20 Arsos G, Venizelos I, Karatzas N, Koukoulidis A, Karakatsanis C. Low-grade chondrosarcomas: a difficult target for radionuclide imaging. Case report and review of the literature. Eur J Radiol 2002; 43 (1) 66-72
21 Shin DS, Shon OJ, Han DS, Choi JH, Chun KA, Cho IH. The clinical efficacy of (18)F-FDG-PET/CT in benign and malignant musculoskeletal tumors. Ann Nucl Med 2008; 22 (7) 603-609
22 Ho L, Meka M, Gamble BK, Shim JJ, Seto J. Left maxillary sinus malignant fibrous histiocytoma on FDG PET-CT. Clin Nucl Med 2009; 34 (12) 967-968
23 Beal K, Allen L, Yahalom J. Primary bone lymphoma: treatment results and prognostic factors with long-term follow-up of 82 patients. Cancer 2006; 106 (12) 2652-2656
24 Bosch-Barrera J, Arbea L, García-Velloso MJ, Gil-Bazo I, García-Foncillas J, Panizo C. Primary bone lymphoma of mandible and thyroid incidentaloma identified by FDG PET/CT: a case report. Cases J 2009; 2: 6384
25 Breiback F, Julian A, Laurent C , et al. Contribution of the 2-[18F]-fluoro-s-deoxy-D-glucose positron emission tomography/computed tomography to the diagnosis of primary osseous Hodgkin lymphoma. BMJ Case Rep 2009; . Available at: http://www.ncbi.nlm.nih.gov/pubmed/21686679 . Accessed January 14, 2014
26 Lin EC. FDG PET/CT flip flop phenomenon in treated lymphoma of bone. Clin Nucl Med 2006; 31 (12) 803-805
27 Park YH, Kim S, Choi SJ , et al. Clinical impact of whole-body FDG-PET for evaluation of response and therapeutic decision-making of primary lymphoma of bone. Ann Oncol 2005; 16 (8) 1401-1402
28 Kyle RA, Rajkumar SV. Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma. Leukemia 2009; 23 (1) 3-9
29 Bodet-Milin C, Eugène T, Bailly C , et al. FDG-PET in the evaluation of myeloma in 2012. Diagn Interv Imaging 2012; 94: 184-189
30 Durie BG, Salmon SE. A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer 1975; 36 (3) 842-854
31 Durie BG. The role of anatomic and functional staging in myeloma: description of Durie/Salmon plus staging system. Eur J Cancer 2006; 42 (11) 1539-1543
32 Zamagni E, Nanni C, Patriarca F , et al. A prospective comparison of 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance imaging and whole-body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma. Haematologica 2007; 92 (1) 50-55
33 Bartel TB, Haessler J, Brown TL , et al. F18-fluorodeoxyglucose positron emission tomography in the context of other imaging techniques and prognostic factors in multiple myeloma. Blood 2009; 114 (10) 2068-2076
34 Agarwal A, Chirindel A, Shah BA, Subramaniam RM. Evolving role of FDG PET/CT in multiple myeloma imaging and management. AJR Am J Roentgenol 2013; 200 (4) 884-890
35 Caldarella C, Isgrò MA, Treglia I, Treglia G. Is fluorine-18-fluorodeoxyglucose positron emission tomography useful in monitoring the response to treatment in patients with multiple myeloma?. Int J Hematol 2012; 96 (6) 685-691
36 Nakayama M, Okizaki A, Ishitoya S, Aburano T. “Hot” vertebra on (18)F-FDG PET scan: a case of vertebral hemangioma. Clin Nucl Med 2012; 37 (12) 1190-1193
37 Domínguez M, Rayo J, Serrano J , et al. Vertebral hemangioma: “Cold” vertebrae on bone scintigraphy and fluorodeoxyglucose positron emission tomography-computed tomography. Indian J Nucl Med 2011; 26 (1) 49-51
38 Basu S, Nair N. “Cold” vertebrae on F-18 FDG PET: causes and characteristics. Clin Nucl Med 2006; 31 (8) 445-450
39 Cardona S, Schwarzbach M, Hinz U. Evaluation of F18-deoxyglucose positron emission tomography (FDG-PET) to assess the nature of neurogenic tumorous. Eur J Surg Oncol 2003; 29 (6) 536-541
40 Nose H, Otsuka H, Otomi Y , et al. Correlations between F-18 FDG PET/CT and pathological findings in soft tissue lesions. J Med Invest 2013; 60 (3-4) 184-190
41 Otsuka H, Graham MM, Kubo A, Nishitani H. FDG-PET/CT findings of sarcomatous transformation in neurofibromatosis: a case report. Ann Nucl Med 2005; 19 (1) 55-58
42 Su MG, Tian R, Fan QP , et al. Recognition of fibrous dysplasia of bone mimicking skeletal metastasis on 18F-FDG PET/CT imaging. Skeletal Radiol 2011; 40 (3) 295-302
43 Aras M, Ones T, Dane F , et al. False positive FDG PET/CT resulting from fibrous dysplasia of the bone in the work-up of a patient with bladder cancer: case report and review of the literature. Iran J Radiol 2012; 10 (1) 41-44
44 Bonekamp D, Jacene H, Bartelt D, Aygun N. Conversion of FDG PET activity of fibrous dysplasia of the skull late in life mimicking metastatic disease. Clin Nucl Med 2008; 33 (12) 909-911
45 Santiago Chinchilla A, Ramos Font C, Tello Moreno M , et al. Fibrous dysplasia of the bone. Contribution of nuclear medicine in the diagnosis of suspicion of sarcomatous degeneration. [in Spanish]. Rev Esp Med Nucl 2010; 29 (4) 172-176
46 Dinauer PA, Brixey CJ, Moncur JT, Fanburg-Smith JC, Murphey MD. Pathologic and MR imaging features of benign fibrous soft-tissue tumors in adults. Radiographics 2007; 27 (1) 173-187
47 Kessels LW, Simsek S, Van Hattum AH, Stam F, Comans EF. Nodular fasciitis: an unexpected finding on computed tomography and positron emission tomography. Eur J Intern Med 2004; 15 (3) 183-185
48 Gotthardt M, Arens A, van der Heijden E, de Geus-Oei LF, Oyen WJ. Nodular fasciitis on F-18 FDG PET. Clin Nucl Med 2010; 35 (10) 830-831
49 Wagner LM, Gelfand MJ, Laor T, Ryckman FC, Al-Ghawi H, Bove KE. A welcome surprise: nodular fasciitis presenting as soft tissue sarcoma. J Pediatr Hematol Oncol 2011; 33 (4) 316-319
50 Lee SM. Nodular fasciitis mimicking malignant tumor on 18F-FDG PET/CT. . Korean J Nucl Med 2005; 39 (4) 263-265