Juliana Sanches Romanato MD, Presenter: Nothing to Disclose

Allan de Oliveira Santos MD, PhD, Abstract Co-Author: Nothing to Disclose

Conrado Furtado Albuquerque Cavalcanti MD, Abstract Co-Author: Nothing to Disclose

Marcelo Bordalo-Rodrigues MD, Abstract Co-Author: Nothing to Disclose

Giovanni Guido Cerri MD, PhD, Abstract Co-Author: Nothing to Disclose

Elba De Sa Camargo Etchebehere MD, PhD, Abstract Co-Author: Nothing to Disclose

Focal areas of increased 18F-FDG uptake in the bones on PET/CT studies are frequently indeterminate. Since the majority of the studies are oncological, these focal areas of increased metabolic activity are always suspicious and sometimes only defined by histopathology. The purpose of this study was to correlate the maximum standardized uptake value (SUV) of 18F-FDG positive bone lesions with the hystopathology after percutaneous biopsy for possible prediction of malignancy.  

Twenty-seven (27) patients were retrospectively reviewed. All patients with 18F-FDG uptake on the PET/CT studies were submitted to percutaneous CT guided bone biopsies. Histopathology findings were correlated with the SUV of the bone lesions.

Six of the twenty-seven patients (21%) had benign findings. Among these there were 3 reactive bone marrow hyperplasia (SUVs: 2.1; 2.6 ; 3.9); two Langerhans cells histiocytosis (SUVs: 4.0 and 5.5); one discitis (SUV = 6.5). The majority (77.7%) of the cases were malignant and corresponded to metastases (breast, colon, lung, melanoma, gastric and prostate cancer), primary bone lymphoma, secondary lymphoma, chordoma, plasmacytoma and multiple myeloma. These lesions had SUVs ranging from 2.2 to 24.8 (mean SUV = 8.0 ± 5.1). 

The probability of bone malignancy is higher among lesions with higher SUV values, although some overlap between malignant and benign lesions may occur. Infectious lesions may exhibit high SUV values while a few malignant lesions (such as metastases of gastric cancer) may exhibit low SUV values.

Although SUV is not a definitive parameter, when elevated, malignant disease is more probable. These suspicious lesions should be confirmed with biopsy if they will alter patient management.

Romanato, J, Santos, A, Cavalcanti, C, Bordalo-Rodrigues, M, Cerri, G, Etchebehere, E, Is SUV Predictor of Malignancy in 18F-FDG-PET/CT Uptaking Bone Lesions? Correlation with Biopsy Findings .  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12028502.html