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The Role of Quantitative ¹⁸F-FDG PET Studies for the Differentiation of Malignant and Benign Bone Lesions

¹ Division of Oncological Diagnostics and Therapy, German Cancer Research Center, Heidelberg, Germany
² Department of Orthopedic Clinics, University of Heidelberg, Heidelberg, Germany
³ Department of Nuclear Medicine, University of Zürich, Zürich, Switzerland

The role of quantitative ¹⁸F-FDG PET studies for the differentiation of benign and malignant bone lesions is still an open question. Methods: Our evaluation included 83 patients with 37 histologically proven malignancies and 46 benign lesions. Thirty-five of the 46 benign lesions were histologically confirmed. The ¹⁸F-FDG studies were accomplished as a dynamic series for 60 min. Evaluation of the ¹⁸F-FDG kinetics was performed using the following parameters: standardized uptake value (SUV), global influx (Ki), computation of the transport constants K1–k4 with consideration of the distribution volume (VB) according to a 2-tissue-compartment model, fractal dimension based on the box-counting procedure (parameter for the inhomogeneity of the tumors). Results: The mean SUV, the vascular fraction VB, K1, and k3 were higher in malignant tumors compared with benign lesions (t test; P < 0.05). Although the ¹⁸F-FDG SUV was helpful to differentiate benign and malignant tumors, there was some overlap, which limited the diagnostic accuracy. On the basis of the discriminant analysis, the SUV alone showed a sensitivity of only 54.05%, a specificity of 91.30%, and a diagnostic accuracy of 74.70%. The fractal dimension was superior and showed a sensitivity of 71.88%, a specificity of 81.58%, and an accuracy of 77.14%. The combination of SUV, fractal dimension, VB, K1–k4, and Ki revealed the best results with a sensitivity of 75.86%, a specificity of 97.22%, and an accuracy of 87.69%. Bayesian analysis showed true-positive results at the level of 0.8 for a low prevalence of disease (0.235) if the full kinetic data were used in the evaluation. Conclusion: ¹⁸F-FDG PET has a high specificity for the exclusion of a malignant bone tumor. Evaluation of the full ¹⁸F-FDG kinetics and the application of discriminant analysis are required and can be used prospectively to classify a bone lesion as malignant or benign.

Key Words: ¹⁸F-FDG PET • bone lesion • fractal dimension • kinetics

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