Abstract
Objective: To evaluate the usefulness of positron emission tomography with [fluorine-18]2-deoxy-2-fluoro-d-glucose (FDG-PET) for early differential diagnosis of benign and malignant fractures.Materials and Methods: Among 1,164 patients who had received FDG-PET between January 1999 and December 2000, 20 patients were found to have an acute fracture on review of clinical charts and/or radiologic images taken within one month before or after FDG-PET examination. The fractures were finally diagnosed by clinical follow up of at least five months duration. Standardized uptake values (SUV) for the benign and malignant bone lesions were calculated and compared.Results: Ten of the 20 patients were finally diagnosed to have a benign fracture, nine patients to have a malignant fracture, and one patient to have both a benign and a malignant fracture at different locations. A statistically significant difference in the SUV was found between the benign group (SUV: 1.36±0.49) and the malignant group (SUV: 4.46±2.12) (p=0.0006, the nonparametric Mann-Whitney U test).Conclusions: FDG-PET can be a useful method for early differentiation between acute benign and metastatic fractures. Our retrospective study indicates that an acute benign fracture itself does not show significant FDG uptake.
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Strauss LG, Conti PS. The applications of PET in clinical oncology.J Nucl Med 1991; 32(4): 623–648.
Hoh CK, Schiepers C, Seltzer MA, Gambhir SS, Silverman DH, Czernin J, et al. PET in oncology: will it replace the other modalities?Semin Nucl Med 1997; 27: 94–106.
Brock CS, Meikle SR, Price P. Does fluorine-18 fluorodeoxyglucose metabolic imaging of tumors benefit oncology?Eur J Nucl Med 1997; 24: 691–705.
Kern KA, Brunetti A, Norton JA, Chang AE, Malawer M, Lack E, et al. Metabolic imaging of human extremity musculoskeletal tumors by PET.J Nucl Med 1988; 29 (2): 181–186.
Adler LP, Blair HF, Makley JT, Williams RP, Joyce MJ, Leisure G, et al. Noninvasive grading of musculoskeletal tumors using PET.J Nucl Med 1991; 32 (8): 1508–1512.
Griffeth LK, Dehdashti FD, McGuire AH, McGuire DJ, Perry DJ, Moerlein SM, et al. PET evaluation of soft-tissue masses with fluorine-18 fluoro-2-deoxy-d-glucose.Radiology 1992; 182 (1): 185–194.
Dehdashti FD, Siegel GA, Griffeth LK, Fusselman MJ, Trask DD, MuGuire AH, et al. Benign versus malignant intraosseous lesions: discrimination by means of PET with 2-[F-18] fluoro-2-deoxy-d-glucose.Radiology 1996; 200: 243–247.
Baker LL, Goodman SB, Perkash I, Lane B, Enzmann DR. Benign versus pathologic compression fractures of vertebral bodies: assessment with conventional spin-echo, chemical-shift, and STIR MR imaging.Radiology 1990; 174 (2): 495–502.
Hamacher K, Coenen HH, Stocklin G. Efficient stereospecific synthesis of non-carrier-added 2-[18F] fluoro-2-deoxy-d-glucose using aminopolyether supported nucleophilic substitution.J Nucl Med 1986; 27 (2): 235–238.
Zasadny KR, Wahl RL. Standardized uptake values of normal tissues at PET with 2-[fluorine-18]-fluoro-2-deoxy-d-glucose: variations with body weight and a method for correction.Radiology 1993; 189 (3): 847–850.
Meikle SR, Bailey DL, Hooper PK, Eberl S, Hutton BF, Jones WF, et al. Simultaneous emission and transmission measurements for attenuation correction in whole-body PET.J Nucl Med 1995; 36 (9): 1680–1688.
O'Rourke T, George CB, Redmond J 3rd Davidson H, Cornett P, Fill WL, et al. Spinal computed tomography and computed tomographic metrizamide myelography in the early diagnosis of metastatic disease.J Clin Oncol 1986; 4 (4): 576–583.
Fornasier VL, Czitrom AA. Collapsed vertebrae: a review of 659 autopsies.Clin Orthop 1978; 131: 261–265.
Delpassand ES, Garcia JR, Bhadkamkar V, Podoloff DA. Value of SPECT imaging of the thoracolumbar spine in cancer patients.Clin Nucl Med 1995; 20 (12): 1047–1051.
Frager D, Elkin C, Swerdlow M, Bloch S. Subacute osteoporotic compression fracture: misleading magnetic resonance appearance.Skeletal Radiol 1988; 17 (2): 123–126.
Yuh WT, Zachar CK, Barloon TJ, Sato Y, Sickels WJ, Hawes DR. Vertebral compression fractures: distinction between benign and malignant causes with MR imaging.Radiology 1989; 172 (1): 215–218.
Hayes CW, Jensen ME, Conway WF. Non-neoplastic lesions of vertebral bodies: findings in magnetic resonance imaging.RadioGraphics 1989; 9 (5): 883–903.
Shih TT, Huang KM, Li YW. Solitary vertebral collapse: Distinction between benign and malignant causes using MR patterns.J Magn Reson Imaging 1999; 9 (5): 635–642.
Baur A, Stabler A, Bruning R, Reiser M. Diffusion-weighted MR imaging of bone marrow: differentiation of benign versus patologic compression fractures.Radiology 1998; 207 (2): 349–356.
Baur A, Stabler A, Huber A, Reiser M. Diffusion-weighted magnetic resonance imaging of spinal bone marrow.Semin Musculoskelet Radiol 2001; 5 (1): 35–42.
Hung GU, Tan TS, Kao CH, Wang SJ. Multiple skeletal metastases of Ewing's sarcoma demonstrated on FDG-PET and compared with bone and gallium scans.Gaoxiong Yi Xue Ke Xue Za Zhi 2000; 16 (6): 315–318.
Kao CH, Hsieh JF, Tsai SC, Ho YJ, Yen RF. Comparison and discrepancy of18F-2-deoxyglucose positron emission tomography and Tc-99m MDP bone scan to detect bone metastases.Anticancer Res 2000; 20 (3B): 2189–2192.
Cook GJ, Fogelman I. The role of positron emission tomography in the management of bone metastases.Cancer 2000; 88 (12 Suppl): 2927–2933.
Schulte M, Brecht-Krauss D, Heymer B, Guhlmann A, Hartwig E, Sarkar MR, et al. Grading of tumors and tumorlike lesions of bone: evaluation by FDG PET.J Nucl Med 2000; 41 (10): 1695–1701.
de-Wit M, Bumann D, Beyer W, Herbst K, Clansen M, Hossfeld DK. Whole-body positron emission tomography (PET) for diagnosis of residual mass in patients with lymphoma.Ann Oncol 1997; 8: Suppl: 157–160.
Meyer M, Gast T, Raja S, Hubner K. Increased F-18 FDG accumulation in an acute fracture.Clin Nucl Med 1994; 19 (1): 13–14.
Paul R, Ahonen A, Virtama P, Aho A, Ekfors T. F-18 fluorodeoxyglucose: its potential in differentiating between stress fracture and neoplasia.Clin Nucl Med 1989; 14 (12): 906–908.
Guhlmann A, Brechy-Krauss D, Suger G, Glatting G, Kotzerke J, Kinzl L, et al. Chronic osteomyelitis: detection with FDGPET and correlation with histopathologic findings.Radiology 1998; 206: 749–754.
Palmer WE, Rosenthal DI, Schoenberg OI, Fischman AJ, Simon LS, Rubin RH, et al. Quantification of inflammation in the wrist with gadolinium-enhanced MR imaging and PET with 2-[F-18]-fluoro-2-deoxy-d-glucose.Radiology 1995; 196 (3): 647–655.
Brudin LH, Valind SO, Rhodes CG, et al. Fluorine-18 deoxyglucose uptake in sarcoidosis measured with positron emission tomography.Eur J Nucl Med 1994; 21 (4): 297–305.
Meszaros K, Lang CH, Bagby GJ, Spitzer JJ. Contribution of different organs to increased glucose consumption after endotoxin administration.J Biol Chem 1987; 262 (23): 10965–10970.
Gamelli RL, Liu H, He LK, Hofmann CA. Augmentations of glucose uptake and glucose transport-1 in macrophages following thermal injury and sepsis in mice.J Leukoc Biol 1996; 59: 639–647.
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This paper was presented at the 87th RSNA annual meeting and scientific assembly, 2001.
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Kato, K., Aoki, J. & Endo, K. Utility of FDG-PET in differential diagnosis of benign and malignant fractures in acute to subacute phase. Ann Nucl Med 17, 41–46 (2003). https://doi.org/10.1007/BF02988257
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DOI: https://doi.org/10.1007/BF02988257