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Grading of Tumors and Tumorlike Lesions of Bone: Evaluation by FDG PET

Departments of Trauma, Hand and Reconstructive Surgery; Nuclear Medicine; and Pathology, University of Ulm, Ulm, Germany

View larger version (154K): [in this window] [in a new window]   FIGURE 1. A 14-y-old boy with thoracic high-grade chondroblastic osteosarcoma. (A) Radiograph shows osteolytic destruction of seventh rib. (B) MR image shows inhomogeneous uptake of gadolinium–diethylenetriaminepentaacetic acid within primary lesion and highly vascularized tumor satellite adjacent to diaphragm. (C) PET image before neoadjuvant chemotherapy shows inhomogeneous FDG uptake in primary lesion (T/B, 10.3) and homogeneous hypermetabolism of satellite (T/B, 11.7).

View larger version (137K): [in this window] [in a new window]   FIGURE 2. A 32-y-old woman with stage 3 giant cell tumor of tibial head. (A) Radiograph shows radiolucent, ill-defined lesion located eccentrically in epiphysis and adjacent metaphyseal region with destruction of dorsomedial cortex. (B) MR image shows homogeneous uptake of gadolinium–diethylenetriaminepentaacetic acid within lesion and tumoral infiltration of popliteus muscle. (C) PET image shows highly hypermetabolic lesion suggestive of malignant tumor (T/B, 35.0). (D) Gross specimen shows subchondral extension, cortical destruction, and typical hemorrhagic aspect of giant cell tumor.

View larger version (106K): [in this window] [in a new window]   FIGURE 3. A 10-y-old girl with low-grade periosteal osteosarcoma of femur. (A) Angiogram shows moderate vascularization, saucerization of adjacent cortex, and radiating spicules. (B) MR image shows tumor located at external surface of bone without involvement of marrow cavity. (C) Bone scintigram shows hypermetabolic diaphyseal lesion without anatomic details. (D) PET image shows that tumor is surrounding femur (T/B, 6.1) and that medullary cavity is without elevated uptake, enabling definitive exclusion of classic central osteosarcoma. (E) Gross specimen shows lesion limited to external surface of bone, without medullary penetration.