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Prognostic Significance of ¹⁸F-FDG and ^99mTc-Methylene Diphosphonate Uptake in Primary Osteosarcoma

¹ Department of Nuclear Medicine, Münster University Hospital, Münster, Germany
² Department of Pediatric Hematology and Oncology, Münster University Hospital, Münster, Germany

The purpose of this retrospective analysis was to evaluate the prognostic significance of both initial glucose metabolism as measured by ¹⁸F-FDG PET and osteoblastic activity as measured by ^99mTc-methylene diphosphonate (MDP) bone scintigraphy in osteosarcoma. Methods: In 29 patients (18 male, 11 female; age range, 5–41 y) with primary osteosarcoma, ¹⁸F-FDG uptake and ^99mTc-MDP uptake were measured semiquantitatively (average and maximum tumor-to-nontumor ratios [T/NT_av and T/NT_max, respectively]) using PET and bone scintigraphy at the time of diagnosis. After chemotherapy, the patients underwent surgery for their primary tumor, and the response was determined histologically. Cumulative overall survival and event-free survival were determined by clinical and imaging follow-up of 7–72 mo (median, 28 mo). Results: Clinical and imaging follow-up revealed that the disease relapsed or failed to achieve complete remission in 9 patients and that 6 patients died of the disease. Both overall and event-free survival were significantly better in patients with a low ¹⁸F-FDG T/NT_max (less than the median) than in patients with a high ¹⁸F-FDG T/NT_max (at least the median). The negative relationship of ¹⁸F-FDG T/NT_av, ^99mTc-MDP T/NT_max, and ^99mTc-MDP T/NT_av with overall and event-free survival did not reach a level of significance. ¹⁸F-FDG uptake values correlated moderately and positively with ^99mTc-MDP uptake values, but a level of significance was reached only between ¹⁸F-FDG T/NT_max and ^99mTc-MDP T/NT_av. Conclusion: The initial glucose metabolism of primary osteosarcoma as measured by ¹⁸F-FDG PET using T/NT_max provides prognostic information. High ¹⁸F-FDG uptake correlates with poor outcome. Thus, ¹⁸F-FDG uptake may be complementary to other well-known factors in judging the prognosis in osteosarcoma.

Key Words: ¹⁸F-FDG PET • ^99mTc-methylene diphosphonate bone scintigraphy • osteosarcoma • prognosis • glucose metabolism

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