Spectrum of Focal Benign Musculoskeletal <sup>18</sup>F-FDG Uptake at PET/CT of the Shoulder and Pelvis

Sopov, Vladimir; Bernstine, Hanna; Stern, Dorit; Yefremov, Nikolay; Groshar, David

doi:10.2214/ajr.08.1686

Cited by 13 publications

(7 citation statements)

References 14 publications

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“…At the glenohumeral joint, non-neoplastic uptake can be seen in patients diagnosed with AC [1, 4, 5], osteoarthritis [11], rheumatoid arthritis [12], subacromial impingement [5], and rotator cuff enthesopathy [5]. While patients with a known diagnosis of AC have been shown to have increased focal uptake at the RI and IC [4, 5], the association in the inverse direction had not been studied. This association is of practical importance to imaging specialists who encounter this phenomenon on PET/CT and their patients.…”

Section: Discussionmentioning

confidence: 99%

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Focal uptake at the rotator interval or inferior capsule of shoulder on 18F-FDG PET/CT is associated with adhesive capsulitis

et al. 2017

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Objective To determine if focal increased uptake at the rotator interval (RI) and/or inferior capsule (IC) on 18F-FDG PET/CT (“positive PET”) predicts the presence of adhesive capsulitis (AC). Materials and Methods Three populations were retrospectively examined. Group 1 included 1,137 consecutive 18F-FDG PET/CT studies and was used to determine the prevalence of focal uptake at the RI or IC. Group 2 included 361 cases from a 10-year period with 18F-FDG PET/CT and MRI of shoulder performed within 45 days of each other and was used to enrich the study group. Group 3 included 109 randomly selected patients from the same time frame as groups 1 and 2 and was used to generate the control group. The study group consisted of 15 cases from the 3 groups, which had positive PET findings. PET/CT images were assessed in consensus by two musculoskeletal radiologists. The reference standard for a diagnosis of AC was clinical and was made by review of the medical record by a pain medicine physician. Results The prevalence of focal activity at either the RI or IC (“positive PET”) was 0.53%. Nine patients had a clinical diagnosis of AC and 15 patients had a positive PET. The sensitivity and specificity of PET for detection of AC was 56% and 87%, respectively. PET/CT had a positive likelihood ratio for AC of 6.3 (95% CI: 2.8–14.6). Conclusion Increased uptake at the RI or IC on PET/CT confers a moderate increase in the likelihood of AC.

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Section: Discussionmentioning

confidence: 99%

“…1) [1]. Because signal abnormality at the RI and IC has been associated with adhesive capsulitis (AC) on MRI [2, 3], increased uptake at these locations has been anecdotally linked to AC [1, 4, 5]. However, this association has not been systematically studied.…”

Section: Introductionmentioning

confidence: 99%

Focal uptake at the rotator interval or inferior capsule of shoulder on 18F-FDG PET/CT is associated with adhesive capsulitis

et al. 2017

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“…[ 68 ] Focal physiological uptake in the region of the growth plate and near tendons attachment of muscles can lead to an erroneous diagnosis. [ 69 ] Awareness of these variable patterns of physiological uptake and knowledge of their causative factors is important to avoid potential diagnostic errors.…”

Section: Pitfalls and False Positivesmentioning

confidence: 99%

Spectrum of Flurodeoxyglucose Positron Emission Tomography/Computerized Tomography Findings in Tumors and Tumor-Like Conditions of the Musculoskeletal System

Purandare

Shah

Agrawal

et al. 2021

Indian Journal of Nuclear Medicine

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Bone and soft-tissue tumors display a wide range of metabolic activity on flurodeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT) imaging due to their varying histopathological features. Several benign tumors show high FDG uptake similar to that seen in malignant lesions and their metabolic characteristics can overlap. Certain benign tumors can potentially undergo malignant transformation and FDG PET/CT can play an important role in detecting malignant change. The intensity of metabolic activity on FDG PET/CT correlates with histological grade of malignant tumors and also acts as a valuable prognostic factor. FDG PET/CT plays an important role in the staging work up of bone and soft-tissue malignancies. It has been found to be superior to conventional imaging techniques primarily for detecting distant metastatic disease. Because of its ability to detect metabolic changes, FDG PET/CT is a very useful in assessing response to treatment. Metabolic response seen on FDG PET is a powerful surrogate marker of histopathological response to chemotherapy. The purpose of this article is to study the variable patterns of FDG uptake in tumors of the musculoskeletal system, describe the clinical utility of FDG PET/CT in predicting malignant change in benign tumors and discuss its role in staging, response assessment, and prognostication of malignant lesions.

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“…Clinical correlation with a previous injury and careful review of CT or correlative images are important for determining the cause of FDG uptake in these osseous structures. Benign extraarticular inflammatory disorders that affect surrounding joint tissue, such as tendinopathy, enthesopathy, or bursitis, are associated with focal FDG uptake (20). These conditions can mimic metastasis to the soft tissue around the joint.…”

Section: Benign Pathologic Fdg Uptake Due To Infection and Inflammationmentioning

confidence: 99%

Image-guided Biopsy: What the Interventional Radiologist Needs to Know about PET/CT

et al. 2012

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Positron emission tomography (PET)/computed tomography (CT) with fluorine 18 fluorodeoxyglucose (FDG) is increasingly used in evaluation of oncology patients. Because PET/CT can demonstrate malignancy before morphologic changes are evident, application of PET/CT information to image-guided biopsy can facilitate early histologic diagnosis and staging. However, because FDG uptake is not specific to cancer, PET/CT findings may raise questions about whether uptake in a lesion is an indication for biopsy. To properly select patients for image-guided biopsy, interventional radiologists should be familiar with the biologic significance of FDG uptake and various causes of false-positive uptake. PET/CT images may also become a source of confusion in the interpretation of biopsy results. Various causes of false-positive and false-negative FDG uptake need to be considered, especially when there is a discrepancy between biopsy results and PET/CT findings. False-negative FDG uptake can result from cancers that are too small to be observed or not FDG avid. False-positive FDG uptake can be due to underlying inflammation from recent treatment. Conversely, complete resolution of FDG uptake in a treated lesion does not necessarily indicate absence of viable cells. When questions about PET/CT findings arise in the context of image-guided biopsy, discussion with experienced nuclear imaging physicians is essential.

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Spectrum of Focal Benign Musculoskeletal ¹⁸F-FDG Uptake at PET/CT of the Shoulder and Pelvis

Abstract: A wide spectrum of benign musculoskeletal disorders associated with focal FDG uptake may be detected in cancer patients. This incidental uptake usually does not seem to be a clinically significant finding, but it can affect quality of life.

Cited by 13 publications

References 14 publications

Focal uptake at the rotator interval or inferior capsule of shoulder on 18F-FDG PET/CT is associated with adhesive capsulitis

Focal uptake at the rotator interval or inferior capsule of shoulder on 18F-FDG PET/CT is associated with adhesive capsulitis

Spectrum of Flurodeoxyglucose Positron Emission Tomography/Computerized Tomography Findings in Tumors and Tumor-Like Conditions of the Musculoskeletal System

Image-guided Biopsy: What the Interventional Radiologist Needs to Know about PET/CT

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Spectrum of Focal Benign Musculoskeletal 18F-FDG Uptake at PET/CT of the Shoulder and Pelvis

Abstract: A wide spectrum of benign musculoskeletal disorders associated with focal FDG uptake may be detected in cancer patients. This incidental uptake usually does not seem to be a clinically significant finding, but it can affect quality of life.

Cited by 13 publications

References 14 publications

Focal uptake at the rotator interval or inferior capsule of shoulder on 18F-FDG PET/CT is associated with adhesive capsulitis

Focal uptake at the rotator interval or inferior capsule of shoulder on 18F-FDG PET/CT is associated with adhesive capsulitis

Spectrum of Flurodeoxyglucose Positron Emission Tomography/Computerized Tomography Findings in Tumors and Tumor-Like Conditions of the Musculoskeletal System

Image-guided Biopsy: What the Interventional Radiologist Needs to Know about PET/CT

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Spectrum of Focal Benign Musculoskeletal ¹⁸F-FDG Uptake at PET/CT of the Shoulder and Pelvis