PET/CT in primary musculoskeletal tumours: a step forward

Abstract

Hybrid imaging with combined positron emission tomography/computed tomography (PET/CT) plays an important role in the staging and management of a wide variety of solid tumours. However, its use in the evaluation of musculoskeletal malignancy has not yet entered routine clinical practice. Cross-sectional imaging with magnetic resonance imaging (MR) and computed tomography have well-established roles but there is increasing evidence for the selective use of PET/CT in the management of these patients. The aims of this article are to review the current evidence and clinical applications of PET/CT in primary musculoskeletal tumours and discuss potential future developments using novel PET tracers and integrated PET/MR.

(iii) The basic science of nuclear medicine

“…Emerging evidence suggests that it may have some use in selected high-risk patients with suspected metastatic or recurrent disease, and in the early assessment of treatment response. 25 FDG PET/CT is also limited in its accuracy of differentiating lesser grade malignant tumours from benign lesions, as there can be considerable overlap in the degree of FDG uptake. 26 FDG PET/CT has a higher sensitivity than bone scintigraphy in detecting osseous involvement in some tumour types such as non-small lung cancer, lymphoma and melanoma.…”

Imaging Review of Skeletal Tumors of the Pelvis—Part I: Benign Tumors of the Pelvis

“…Fluorine-labelled fluorodeoxyglusose (FDG) is the most commonly used PET tracer. It is preferentially taken up by the cells, which demonstrate increase in cellular glycolysis, seen in most malignant bone tumors and in some benign conditions like arthritis and infection [14–16]. The degree of uptake of the FDG tracer by the tumor cells when compared to the normal soft tissue background is expressed in terms of standardised uptake value (SUV), a marker of metabolic activity of the tumor [17].…”

Molecular imaging in oncology: the acceptance of PET/CT and the emergence of MR/PET imaging

“…Many studies have been reported and reviews published for common and less common cancers [16, 20–23]; others were focused on lung [17, 24] , breast [25–29], colorectal [30–32], recurrent rectal [33], head & neck [34–36], ovarian [22], uterine [37] and cervical [38, 39], nasopharyngeal [40] and thyroid cancer [41, 42], melanoma [43–45], as well as lympho-proliferative disorders [46–48], carcinoma of unknown primary (CUP) [49], and primary muscular-skeletal tumors [8]. …”

“…Reviews have been published on some of the achievements of the dual imaging modality PET/CT, a powerful, routinely and frequently applied molecular imaging tool for diagnosis, staging and therapy monitoring in oncology [5–8]. …”