Benign Bone Conditions That May Be FDG-avid and Mimic Malignancy

Kwee, Thomas C.; Klerk, John M. H. de; Nix, Maarten; Heggelman, Ben G F; Dubois, Stefan V.; Adams, Hugo J. A.

doi:10.1053/j.semnuclmed.2017.02.004

Cited by 35 publications

(41 citation statements)

References 128 publications

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“…The results of our study show that FDG-PET/CT achieves a fairly high, but not infallible PPV of 85.7% (95% CI, 80.7-89.6%) in discriminating malignant from benign vertebral bone lesions. This is in line with previous work that has shown that there are several benign bone conditions that may be FDG-avid and mimic malignancy, including (focal) red marrow hyperplasia [12]. Semiquantitative FDG-PET/CT measurements had some value in differentiating malignant from benign vertebral bone lesions, with AUCs of 0.630 and 0.671 for SUV max and SUV peak , respectively.…”

Section: Discussionsupporting

confidence: 89%

The value of prebiopsy FDG-PET/CT in discriminating malignant from benign vertebral bone lesions in a predominantly oncologic population

et al. 2020

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Purpose To determine the value of prebiopsy 18 F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET)/computed tomography (CT) in discriminating malignant from benign vertebral bone lesions. Materials and methods This retrospective study included 53 patients with 55 vertebral bone lesions that underwent FDG-PET/ CT before CT-guided biopsy. Pathologic examination of the biopsy sample and a minimum follow-up of 1 year were used as reference standard. Results Sensitivity, specificity, positive predictive value, and negative predictive value of visual FDG-PET analysis (with lesion FDG uptake higher than liver FDG uptake as threshold for malignancy) in discriminating malignant from benign vertebral bone lesions were 91.3% (42/46), 22.2% (2/9), 85.7% (42/49), and 33.3% (2/6), respectively. The semiquantitative FDG-PET metrics SUV max and SUV peak achieved areas under the receiver operating characteristics curve of 0.630 and 0.671, respectively. Malignant lesions demonstrated bone lysis more frequently than benign lesions (60.9% (28/46) vs. 22.2% (2/9)), and this difference was nearly significant (P = 0.064). All other clinical and conventional imaging characteristics (including patient age, gender, previous diagnosis of malignancy, bone pain, weight loss, any CT abnormality, sclerosis, cortical destruction, bone marrow replacement, associated extraosseous soft tissue mass, and accompanying vertebral height loss, multiple bone lesions on FDG-PET/CT, and suspicious extraosseous lesions on FDG-PET/CT) were not significantly different (P = 0.143 to 1.000). Conclusion FDG-PET/CT may steer the diagnosis (particularly thanks to a relatively high PPV and value of semiquantitative measurements), but cannot always classify vertebral bone lesions as malignant or benign with sufficient certainty. In these cases, biopsy and/or follow-up remain necessary to establish a final diagnosis.

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Section: Discussionsupporting

confidence: 89%

The value of prebiopsy FDG-PET/CT in discriminating malignant from benign vertebral bone lesions in a predominantly oncologic population

et al. 2020

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“…Vertebral body hemangiomas have a characteristic striated appearance on radiographs and a corresponding “polka dot” appearance on axial CT images (Figure 3A)[28]. On MRI, hemangiomas typically have high signal on both T1- and T2-weighted images[32] and commonly show loss of signal on in- and out-of-phase gradient sequences[33]. The PET/CT appearance is similar to the CT appearance, with some lesions showing increased 18 F-FDG uptake on PET.…”

Section: Discussionmentioning

confidence: 99%

Positron emission tomography/computed tomography imaging appearance of benign and classic “do not touch” osseous lesions

Elangovan

Sebro

2019

WJR

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BACKGROUND Classic “do not touch” and benign osseous lesions are sometimes detected on 18 -F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) studies. These lesions are often referred for biopsy because the physician interpreting the PET/CT may not be familiar with the spectrum of 18 F-FDG uptake patterns that these lesions display. AIM To show that “do not touch” and benign osseous lesions can have increased 18 F-FDG uptake above blood-pool on PET/CT; therefore, the CT appearance of these lesions should dictate management rather than the standardized uptake values (SUV). METHODS This retrospective study evaluated 287 independent patients with 287 classic “do not touch” (benign cystic lesions, insufficiency fractures, bone islands, bone infarcts) or benign osseous lesions (hemangiomas, enchondromas, osteochondromas, fibrous dysplasia, Paget’s disease, osteomyelitis) who underwent 18 F-FDG positron emission tomography/computed tomography (PET/CT) at a tertiary academic healthcare institution between 01/01/2006 and 12/1/2018. The maximum and mean SUV, and the ratio of the maximum SUV to mean blood pool were calculated. Pearson’s correlations between lesion size and maximum SUV were calculated. RESULTS The ranges of the maximum SUV were as follows: For hemangiomas (0.95-2.99), bone infarcts (0.37-3.44), bone islands (0.26-3.29), enchondromas (0.46-2.69), fibrous dysplasia (0.78-18.63), osteochondromas (1.11-2.56), Paget’s disease of bone (0.93-5.65), insufficiency fractures (1.06-12.97) and for osteomyelitis (2.57-12.64). The range of the maximum SUV was lowest for osteochondromas (maximum SUV 2.56) and was highest for fibrous dysplasia (maximum SUV of 18.63). There was at least one lesion that demonstrated greater 18 F-FDG avidity than the blood pool amongst each lesion type, with the highest maximum SUV ranging from 9.34 times blood pool mean (osteomyelitis) to 1.42 times blood pool mean (hemangiomas). There was no correlation between the maximum SUV and the lesion size except for enchondromas. Larger enchondromas had higher maximum SUV ( r = 0.36, P = 0.02). CONCLUSION The classic “do not touch” lesions and classic benign lesions can be 18 F-FDG avid. The CT appearance of these lesions should dictate clinical management rather than the maximum SUV.

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“…Each year, millions of patients suffer from symptomatic benign bone lesions, including benign bone tumors and nonneoplastic lesions, representing a substantial challenge for orthopedic oncology surgeons due to the lack of evidence-based therapeutic strategies [1] , [2] . With the rapid development of musculoskeletal imaging and interventional radiology, an increasing number of benign bone tumors and nonneoplastic lesions are being detected at the early stage [3] , [4] . Clinically, regular follow-ups and dynamic imaging observations may be suitable for asymptomatic patients with minor bony lesions [5] .…”

Section: Introductionmentioning

confidence: 99%

The minimally invasive endoscopic technique for the treatment of symptomatic benign bone lesions: Preliminary results from a retrospective study

Xiao

Zhang

et al. 2020

Journal of Bone Oncology

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Highlights Symptomatic benign bone lesions may cause pain and refractory limp. Conventional open surgery usually involves high risks of complications, which may greatly compromise the overall efficacy of surgery in the long term. This single-institution retrospective study of 34 patients with symptomatic benign bone lesions. All surgical procedures were performed under endoscopic guidance for direct visualization followed by complete curettage of tumor tissue. Patients reported significant improvements in pain, quality of life and functional recovery without complications or need for secondary interventions. Study limitations included a relatively small population of Chinese patients and the lack of a comparative surgical or other minimally invasive techniques. The procedure described may be a valuable alternative to open surgery for symptomatic benign bone lesions.

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Benign Bone Conditions That May Be FDG-avid and Mimic Malignancy

Cited by 35 publications

References 128 publications

The value of prebiopsy FDG-PET/CT in discriminating malignant from benign vertebral bone lesions in a predominantly oncologic population

The value of prebiopsy FDG-PET/CT in discriminating malignant from benign vertebral bone lesions in a predominantly oncologic population

Positron emission tomography/computed tomography imaging appearance of benign and classic “do not touch” osseous lesions

The minimally invasive endoscopic technique for the treatment of symptomatic benign bone lesions: Preliminary results from a retrospective study

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