False-positive FDG-PET scan due to brown tumours

Baardwijk, Angela van; Jong, J.D. de; Arens, Anne; Thimister, P. W. L.; Verseput, Gaico; Kremer, Bernd; Lambin, Philippe

doi:10.1007/s00259-005-1979-5

Cited by 12 publications

(6 citation statements)

References 5 publications

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“…28 Brown tumors can show markedly increased FDG uptake and appear as expansile, osteolytic lesions, whereas internal septations or sclerosis can be seen in later stages of disease. 28,30,31 Therefore, brown tumors can be confused with malignant disease, particularly when a typical history such as chronic renal disease is absent or when a patient with a known malignancy undergoes FDG-PET for staging or radiation therapy planning (Fig. 3).…”

Section: Brown Tumormentioning

confidence: 99%

“…3). 28,30,31 Note that MRI can show susceptibility artifacts (ie, signal loss, which is particularly pronounced on gradient-echo sequences with long echo times) due to hemosiderin deposition, which can give a clue toward the correct diagnosis. 32 Laboratory investigations should be ordered to support the diagnosis of a brown tumor, which will reveal Figure 1 Radiographs of the left humerus in 51-year-old man who presented with pain in the left upper arm since 8 weeks show a large osteolytic lesion with endosteal scalloping and cortical thinning (A and B, arrows).…”

Section: Brown Tumormentioning

confidence: 99%

See 1 more Smart Citation

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

Kwee

Klerk

Nix

et al. 2017

Seminars in Nuclear Medicine

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Section: Brown Tumormentioning

confidence: 99%

Section: Brown Tumormentioning

confidence: 99%

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

Kwee

Klerk

Nix

et al. 2017

Seminars in Nuclear Medicine

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“…Furthermore, FCH PET/CT was superior in demonstrating ectopic localization of HPT in comparison with US and MIBI. Similar to MIBI scintigraphy, FCH PET/CT could identify brown tumors, which are bone lesions that arise as a result of increased osteoclastic activity in hyperparathyroidism and mimic bone metastasis (24)(25)(26), which was also documented by Taywade et al (27) previously.…”

Section: Fch Pet/ct (A-c) and Mibi Spect/ct (D-i) Findings For 48-ymentioning

confidence: 57%

Performance of F-18 Fluorocholine PET/CT for Detection of Hyperfunctioning Parathyroid Tissue in Patients with Elevated Parathyroid Hormone Levels and Negative or Discrepant Results in conventional Imaging

et al. 2020

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Objective: Our aim was to assess the diagnostic performance of F-18 fluorocholine (FCH) positron emission tomography/ computed tomography (PET/CT) in detecting hyperfunctioning parathyroid tissue (HPT) in patients with elevated parathyroid hormone levels with negative or inconclusive conventional imaging results and to compare the findings with those obtained using technetium-99m sestamibi (MIBI) scintigraphy and neck ultrasonography (US). Materials and Methods: Images of 105 patients with hyperparathyroidism who underwent FCH PET/CT, dual-phase MIBI parathyroid scintigraphy (median interval: 42 days), and neck US were retrospectively analyzed. The gold standard was histopathological findings for 81 patients who underwent parathyroidectomy and clinical follow-up findings in the remaining 24 patients. Sensitivities, positive predictive values (PPVs), and accuracies were calculated for all imaging modalities. Results: Among the 81 patients who underwent parathyroidectomy, either parathyroid adenoma (n = 64), hyperplasia (n = 9), neoplasia (n = 4), or both parathyroid adenoma and hyperplasia (n = 1) were detected, except 3 patients who did not show HPT. Of the 24 (23%) patients who were followed-up without operation, 22 (92%) showed persistent hyperparathyroidism. FCH PET/CT showed significantly higher sensitivity than MIBI scintigraphy and US in detection of HPT (p < 0.01). Sensitivity, PPV, and accuracy of FCH PET/CT were 94.1% (95/101), 97.9% (95/97), and 92.4% (97/105), respectively. The corresponding values for MIBI scintigraphy and US were 45.1% (46/102), 97.9% (46/47), and 45.7% (48/105) and 44.1% (45/102), 93.8% (45/48), and 42.9% (45/105), respectively. Among the 35 patients showing negative MIBI scintigraphy and neck US findings, 30 (86%) showed positive results on FCH PET/CT. FCH PET/CT could demonstrate ectopic locations of HPT in 11 patients whereas MIBI and US showed positive findings in only 6 and 3 patients, respectively. Conclusion: FCH PET/CT is an effective imaging modality for detection of HPT with the highest sensitivity among the available imaging techniques. Therefore, FCH PET/CT can be recommended especially for patients who show negative or inconclusive results on conventional imaging.

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“…One manifestation of abnormal bone resorption is brown tumor, appearing as osteolytic areas with increased glucose metabolism, in the long and flat bones (A and D, curved arrow). 5,6 The incidence of brown tumors is low in primary and secondary hyperparathyroidism, ranging 1.5% to 5%, and the overexpression of GLUT transporters on the surface of the multinucleated giant macrophagic cells in brown tumors is likely the cause of the increased FDG uptake. 7 On 99m Tc-MDP scintigraphy, brown tumors are described in the literature as areas of decreased uptake due pure osteolytic character or area circumscribed by an increased uptake border in case of reaction of the surrounding bone.…”

Section: Figurementioning

confidence: 99%

Secondary Hyperparathyroidism With “Superscan-Like” Hypermetabolic FDG PET/CT Pattern

Grellier

Lussato²,

Queneau³

et al. 2015

Clinical Nuclear Medicine

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A 26-year-old man with chronic terminal renal insufficiency under dialysis was referred in our institution for a checkup before kidney transplantation to ensure the absence of malignant neoplasm. The patient had a biological secondary hyperparathyroidism with highly elevated serum parathormon, and treatment with parathyroid surgery was planned before the kidney transplant. Whole-body FDG PET/CT showed no apparent malignant neoplasm, but increased metabolism of the 4 parathyroid gland and the other pitfalls of advanced secondary hyperparathyroidism on chronic renal insufficiency: pseudotumoral calcification in soft tissues, diffuse hypermetabolic bone dystrophy, and osteolytic lesion of pelvic and peripheral skeleton corresponding to brown tumors.

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False-positive FDG-PET scan due to brown tumours

Cited by 12 publications

References 5 publications

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

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

Performance of F-18 Fluorocholine PET/CT for Detection of Hyperfunctioning Parathyroid Tissue in Patients with Elevated Parathyroid Hormone Levels and Negative or Discrepant Results in conventional Imaging

Secondary Hyperparathyroidism With “Superscan-Like” Hypermetabolic FDG PET/CT Pattern

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