Abstract
2044
Objectives: 1. To review and characterize the role of PET in imaging primary and metastatic tumors of the spine and vertebral bodies.2. To explain the recent developments of PET imaging and radiological assessment sarcomas of the spine.
Methods: Original studies and reviews involving PET or combination of imaging modalities related to primary and metastatic sarcomas affecting the spine were acquired via Google Scholar and PubMed search engines. The quality of the imaging studies was assessed by examining conclusions, number of patients, and significance of findings. Results: A variety of studies and case reports have reported successes in applying different imaging modalities in cancers of the spine and particularly, the vertebral body. While there are advantages of each modality, superior utility was found when utilized combined structural imaging (i.e. MRI or CT) with PET modalities; there was particular value in diagnosing bone cancers in the vertebral column as well as evaluating the effectiveness of chemotherapeutic treatment overtime. Both FDG-PET and NaF-PET have been able to provide intrinsic insights into the metabolic activities of the tumors present in patients; though FDG presents as a better tracer in diagnosis, initial studies have shown NaF, as a more specific radiotracer, to be useful not only in treatment response monitoring, but also in the initial staging in especially osteogenic sarcoma. Several studies have discussed the application of PET/CT in the diagnosis of metastatic tumors to the vertebral bodies often seen in e.g. Ewing’s Sarcoma and cervical spine myeloid sarcoma.
Conclusions: Although CT and MRI are non-invasive imaging modalities and MRI pose no radiation, they falter when differentiating neoplastic tissues particularly in realm of sarcoma. FDG-PET is the ideal means of evaluating metabolic activity with greater sensitivity in detecting early bone marrow changes than bone scintigraphy; further, specificity is increased when hybrid imaging with CT is performed. FDG PET/CT has been described to have success in detecting lesions in rare vertebral anomalies from diseases such as Kaposi Sarcoma and better reaching prognoses and particular treatment response in cases of Ewing’s Sarcoma. There is a need for more studies to evaluate the use of PET/CT, such as examining NaF uptake to evaluate progression of vertebral body osteosarcomas, but the literature does suggest affirming the clinical utility of PET and predicts further added value with developments in the future.