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OtherClinical Investigations

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

Antonia Dimitrakopoulou-Strauss, Ludwig G. Strauss, Thomas Heichel, Hua Wu, Cyrill Burger, Ludger Bernd and Volker Ewerbeck
Journal of Nuclear Medicine April 2002, 43 (4) 510-518;
Antonia Dimitrakopoulou-Strauss
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Ludwig G. Strauss
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Thomas Heichel
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Hua Wu
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Cyrill Burger
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Ludger Bernd
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Volker Ewerbeck
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  • FIGURE 1.
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    FIGURE 1.

    (A) Conventional radiographic image of left knee (lateral view) shows irregular osteoblastic mass dorsal of femur. (B) Transversal PET image (SUV image) of distal femur shows enhanced 18F-FDG uptake confined to femoral part of mass. (C) Parametric image of fractal dimension of image in B. Increased fractal dimension (red area) is indicative of chaotic 18F-FDG metabolism. Note that area of chaotic metabolism is larger than 18F-FDG uptake region on SUV image (B). Histologic examination revealed osteosarcoma.

  • FIGURE 2.
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    FIGURE 2.

    Transversal (A), sagittal (B), and coronal (C) images of patient with histologically confirmed fibrous dysplasia of distal part of left femur 1 h after 18F-FDG injection show high 18F-FDG uptake in suspicious lesion. Cross cursor is positioned over suspicious lesion according to clinical examination. PET images are visualized with PMod software package. Cube indicates relative position of cursor in volume of view.

  • FIGURE 3.
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    FIGURE 3.

    Box—whiskers plots of average 18F-FDG uptake (SUV) at 55–60 min and average of fractal dimension for all malignant (n=37) and all benign (n=46) lesions.

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    FIGURE 4.

    (A) Bayesian analysis applied to all data shows that probabilities of true-positive (TP) and false-negative (FN) results using 4 different parameters (red curve, SUV; blue curve, fractal dimension; green curve, SUV + fractal dimension; purple curve, all parameters) for evaluation are dependent on prevalence of disease. Solid curves represent posterior probability of true-positive results and dashed curves represent posterior probability of false-negative results. (B) Discriminant curves (difference of absolute values between posterior probability true-positive and posterior probability false-negative) for 4 different parameters of A indicating profit in information using PET. Full kinetic analysis (purple curve) is superior to all other parameters and provides maximum information at low level of prior probability.

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    TABLE 1

    Descriptive Statistics for All Malignant Tumors

    VariableNo. of lesionsMinimumMaximumMedianMean ± SD
    18F-FDG (SUV)370.44612.2903.0573.694 ± 2.985
    VB300.0430.9130.2790.334 ± 0.264
    K1 (1/min)320.0090.8430.2500.312 ± 0.294
    k2 (1/min)320.0000.8700.2830.304 ± 0.309
    k3 (1/min)320.0000.8540.0480.085 ± 0.159
    k4 (1/min)320.0000.5890.0040.027 ± 0.105
    Fractal dimension320.5491.4861.2371.206 ± 0.193
    • View popup
    TABLE 2

    Descriptive Statistics for Benign Lesions

    VariableNo. of lesionsMinimumMaximumMedianMean ± SD
    18F-FDG (SUV)460.3893.5410.8851.145 ± 0.762
    VB380.0000.7810.1310.204 ± 0.205
    K1 (1/min)380.0270.7790.1760.222 ± 0.174
    k2 (1/min)380.0090.9810.3090.394 ± 0.275
    k3 (1/min)380.0000.2420.0230.048 ± 0.060
    k4 (1/min)380.0000.2060.0020.025 ± 0.047
    Fractal dimension380.7641.3491.0211.045 ± 0.147
    • View popup
    TABLE 3

    Sensitivity, Specificity, and Accuracy for All Lesions Using 4 Different Combinations of Evaluation Parameters as Input Variables for DA

    ParameterSUVFDSUV, FDSUV, FD, VB, K1–k4, Ki*
    Sensitivity (%)54.05 (20/37)71.88 (23/32)64.52 (20/31)75.86 (22/29)
    Specificity (%)91.30 (42/46)81.58 (31/38)88.89 (32/36)97.22 (35/36)
    Accuracy (%)74.70 (62/83)77.14 (54/70)77.61 (52/67)87.69 (57/65)
    • ↵* Combination of evaluation parameters according to Patlak and Blasberg (10).

    • FD=fractal dimension.

    • Full kinetic analysis was possible in 29 of 37 tumors and 36 of 46 benign lesions.

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Journal of Nuclear Medicine: 43 (4)
Journal of Nuclear Medicine
Vol. 43, Issue 4
April 1, 2002
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The Role of Quantitative 18F-FDG PET Studies for the Differentiation of Malignant and Benign Bone Lesions
Antonia Dimitrakopoulou-Strauss, Ludwig G. Strauss, Thomas Heichel, Hua Wu, Cyrill Burger, Ludger Bernd, Volker Ewerbeck
Journal of Nuclear Medicine Apr 2002, 43 (4) 510-518;

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The Role of Quantitative 18F-FDG PET Studies for the Differentiation of Malignant and Benign Bone Lesions
Antonia Dimitrakopoulou-Strauss, Ludwig G. Strauss, Thomas Heichel, Hua Wu, Cyrill Burger, Ludger Bernd, Volker Ewerbeck
Journal of Nuclear Medicine Apr 2002, 43 (4) 510-518;
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