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. 2008 Aug;22(7):603-9.
doi: 10.1007/s12149-008-0151-2. Epub 2008 Aug 29.

The clinical efficacy of (18)F-FDG-PET/CT in benign and malignant musculoskeletal tumors

Duk-Seop Shin  1 , Oog-Jin Shon, Dong-Sung Han, Joon-Hyuk Choi, Kyung-Ah Chun, Ihn-Ho Cho
Affiliations

The clinical efficacy of (18)F-FDG-PET/CT in benign and malignant musculoskeletal tumors

Duk-Seop Shin et al. Ann Nucl Med. 2008 Aug.

Abstract

Objective: Most of the current clinical data on the role of 2-[(18)F]fluoro-2-deoxy-D -glucose positron emission tomography ((18)F-FDG-PET) in musculoskeletal tumors come from patients studied with PET and less frequently with hardware fusion PET/computed tomography (CT). And the number of cases in each report is too small to clarify the exact clinical efficacy of PET or PET/CT. This prompted us to analyze our experience with (18)F-FDG-PET/CT in a relatively large group of patients with musculoskeletal tumors.

Methods: (18)F-FDG-PET/CT was performed on 91 patients from May 2004 to June 2007. The final diagnosis was obtained from surgical biopsy in 83 patients (91%) and clinical follow-up in 8 (9%). We analyzed the characteristics and amount of (18)F-FDG uptake in soft tissue and bone tumors, and investigated the ability of (18)F-FDG-PET/CT to differentiate malignant from benign tumors. The cutoff maximum standardized uptake value (SUV(max)) was calculated using the receiver-operation characteristic curve method. Sensitivity, specificity, and diagnostic accuracy were calculated with cutoff SUV(max) and the final diagnosis. Unpaired t test was used for the statistical analysis.

Results: Final diagnosis revealed 19 benign soft tissue tumors (mean SUV(max) 4.7), 27 benign bone tumors (5.1), 25 malignant soft tissue tumors (8.8), and 20 malignant bone tumors (10.8). There was a significant difference in SUV(max) between benign and malignant musculoskeletal tumors in total (P < 0.002), soft tissue tumors (P < 0.05), and bone tumors (P < 0.02). Sensitivity, specificity, and diagnostic accuracy were 80%, 65.2%, and 73% in total with cutoff SUV(max) 3.8, 80%, 68.4%, and 75% in the soft tissue tumors with cutoff SUV(max) 3.8, and 80%, 63%, and 70% in the bone tumors with cutoff SUV(max) 3.7.

Conclusions: (18)F-FDG-PET/CT reliably differentiated malignant soft tissue and bone tumors from benign ones, although there were many false-positive and false negative lesions. Further studies with all kinds of musculoskeletal tumors in large numbers are needed to improve the diagnostic accuracy of (18)F-FDG-PET/CT.

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