TY - JOUR T1 - The Role of Quantitative <sup>18</sup>F-FDG PET Studies for the Differentiation of Malignant and Benign Bone Lesions JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 510 LP - 518 VL - 43 IS - 4 AU - Antonia Dimitrakopoulou-Strauss AU - Ludwig G. Strauss AU - Thomas Heichel AU - Hua Wu AU - Cyrill Burger AU - Ludger Bernd AU - Volker Ewerbeck Y1 - 2002/04/01 UR - http://jnm.snmjournals.org/content/43/4/510.abstract N2 - 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 &lt; 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. ER -