Skip to main content
Top
Published in: Skeletal Radiology 3/2011

01-03-2011 | Scientific Article

Recognition of fibrous dysplasia of bone mimicking skeletal metastasis on 18F-FDG PET/CT imaging

Authors: Ming Gang Su, Rong Tian, Qiu Ping Fan, Ye Tian, Fang Lan Li, Lin Li, An Ren Kuang, John Howard Miller

Published in: Skeletal Radiology | Issue 3/2011

Login to get access

Abstract

Purpose

Fibrous dysplasia of bone (FDB) reveals intense 18F-FDG uptake mimicking metastases on 18F-FDG PET/CT. We reviewed sites of FDB revealed by 18F-FDG PET/CT imaging to allow identification of this abnormality.

Materials and Methods

Eleven patients (7 male, 4 female, aged 16–78 years) were evaluated after 55 MBq (0.15 mCi)/kg 18F-FDG utilizing a 16-slice multiple detector CT (MDCT) whole-body PET scanner, with LOR algorithm 3D reconstruction. One- and 2-h imaging was performed in 9 patients. Standard uptake value (SUV) for each lesion, on early and delayed imaging, was calculated. Lesions were confirmed in 6 patients by biopsy. The PET images correlated with MDCT to establish the imaging characteristics.

Results

Solitary lesions were found in 4 patients, two lesions in 1 patient, and in 6 patients there were multiple bone lesions. The SUVearly ranged from 1.23 to 9.64 with an average of 3.76 ± 2.40. The SUVdelayed ranged from 1.76 to 11.42 with an average of 4.51 ± 3.07. The SUVdelayed decreased or increased slightly (−31% to 5%) in 6 of our patients, and increased significantly (11% to 39%) in 3. There was a negative correlation between SUVs and age, as well as the number of affected bones.

Conclusions

In our study, FDB had wide skeletal distribution with variability of 18F-FDG uptake and CT appearance. SUV in the delayed stage was seen to either decrease or increase on dual-time 18F-FDG PET scanning. It is very important to recognize the characteristics of this skeletal dysplasia to allow differentiation from skeletal metastasis.
Literature
1.
go back to reference Campanacci M. Bone and soft tissue tumors: clinical features, imaging, pathology and treatment. 2nd ed. New York: Springer; 1999. Campanacci M. Bone and soft tissue tumors: clinical features, imaging, pathology and treatment. 2nd ed. New York: Springer; 1999.
2.
go back to reference Weinstein LS, Shenker A, Gejman PV, Merino MJ, Friedman E, Spiegel AM. Activating mutations of the stimulatory G protein in the Mc-Cune-Albright Syndrome. N EngI J Med. 1991;325:1688–95.CrossRef Weinstein LS, Shenker A, Gejman PV, Merino MJ, Friedman E, Spiegel AM. Activating mutations of the stimulatory G protein in the Mc-Cune-Albright Syndrome. N EngI J Med. 1991;325:1688–95.CrossRef
3.
go back to reference DiCaprio MR, Enneking WF. Fibrous dysplasia. pathophysiology, evaluation, and treatment. J Bone Joint Surg Am. 2005;87:1848–64.CrossRefPubMed DiCaprio MR, Enneking WF. Fibrous dysplasia. pathophysiology, evaluation, and treatment. J Bone Joint Surg Am. 2005;87:1848–64.CrossRefPubMed
4.
go back to reference Parekh SG, Donthineni-Rao R, Ricchetti E, Lackman RD. Fibrous dysplasia. J Am Acad Orthop Surg. 2004;12:305–13.PubMed Parekh SG, Donthineni-Rao R, Ricchetti E, Lackman RD. Fibrous dysplasia. J Am Acad Orthop Surg. 2004;12:305–13.PubMed
5.
go back to reference Fitzpatrick KA, Taljanovic MS, Speer DP, Graham AR, Jacobson JA, Barnes GR, et al. Imaging findings of fibrous dysplasia with histopathologic and intraoperative correlation. AJR Am J Roentgenol. 2004;182:1389–98.PubMed Fitzpatrick KA, Taljanovic MS, Speer DP, Graham AR, Jacobson JA, Barnes GR, et al. Imaging findings of fibrous dysplasia with histopathologic and intraoperative correlation. AJR Am J Roentgenol. 2004;182:1389–98.PubMed
6.
go back to reference Zhuang HM, Pourdehnad M, Lambright ES, Yamamoto AJ, Lanuti M, Li P, et al. Dual time point 18F-FDG PET imaging for differentiating malignant from inflammatory processes. J Nucl Med. 2001;42:1412–7.PubMed Zhuang HM, Pourdehnad M, Lambright ES, Yamamoto AJ, Lanuti M, Li P, et al. Dual time point 18F-FDG PET imaging for differentiating malignant from inflammatory processes. J Nucl Med. 2001;42:1412–7.PubMed
7.
go back to reference Demura Y, Tsuchida T, Ishizaki T, Mizuno S, Totani Y, Ameshima S, et al. 18F-FDG accumulation with PET for differentiation between benign and malignant lesions in the thorax. J Nucl Med. 2003;44:540–8.PubMed Demura Y, Tsuchida T, Ishizaki T, Mizuno S, Totani Y, Ameshima S, et al. 18F-FDG accumulation with PET for differentiation between benign and malignant lesions in the thorax. J Nucl Med. 2003;44:540–8.PubMed
8.
go back to reference Aoki J, Watanabe H, Shinozaki T, Takagishi K, Ishijima H, Oya N, et al. FDG PET of primary benign and malignant bone tumors: standardized uptake value in 52 lesions. Radiology. 2001;219:774–7.PubMed Aoki J, Watanabe H, Shinozaki T, Takagishi K, Ishijima H, Oya N, et al. FDG PET of primary benign and malignant bone tumors: standardized uptake value in 52 lesions. Radiology. 2001;219:774–7.PubMed
9.
go back to reference Schulte M, Brecht-Krauss D, Heymer B, Guhlmann A, Hartwig E, Sarkar MR, et al. Grading of tumors and tumorlike lesions of bone: evaluation by FDG PET. J Nucl Med. 2000;41:1695–701.PubMed Schulte M, Brecht-Krauss D, Heymer B, Guhlmann A, Hartwig E, Sarkar MR, et al. Grading of tumors and tumorlike lesions of bone: evaluation by FDG PET. J Nucl Med. 2000;41:1695–701.PubMed
10.
go back to reference Von Falck C, Rosenthal H, Laenger F, Lotz J, Knapp WH, Galanski M. Avid uptake of [18F]-FDG in fibrous dysplasia can mimic skeletal involvement in Hodgkin’s disease. Eur J Nucl Med Mol Imaging. 2008;35:223.CrossRef Von Falck C, Rosenthal H, Laenger F, Lotz J, Knapp WH, Galanski M. Avid uptake of [18F]-FDG in fibrous dysplasia can mimic skeletal involvement in Hodgkin’s disease. Eur J Nucl Med Mol Imaging. 2008;35:223.CrossRef
11.
go back to reference Stegger L, Juergens KU, Kliesch S, Wormanns D, Weckesser M. Unexpected finding of elevated glucose uptake in fibrous dysplasia mimicking malignancy: contradicting metabolism and morphology in combined PET/CT. Eur Radiol. 2007;17:1784–6.CrossRefPubMed Stegger L, Juergens KU, Kliesch S, Wormanns D, Weckesser M. Unexpected finding of elevated glucose uptake in fibrous dysplasia mimicking malignancy: contradicting metabolism and morphology in combined PET/CT. Eur Radiol. 2007;17:1784–6.CrossRefPubMed
12.
go back to reference Zou KH, Tuncali K, Silverman SG. Correlation and simple linear regression. Radiology. 2003;227:617–28.CrossRefPubMed Zou KH, Tuncali K, Silverman SG. Correlation and simple linear regression. Radiology. 2003;227:617–28.CrossRefPubMed
13.
go back to reference Hellwig D, Graeter TP, Ukena D, Groeschel A, Sybrecht GW, Schaefers H, et al. 18F-FDG PET for mediastinal staging of lung cancer: which SUV threshold makes sense? J Nucl Med. 2007;48:1761–6.CrossRefPubMed Hellwig D, Graeter TP, Ukena D, Groeschel A, Sybrecht GW, Schaefers H, et al. 18F-FDG PET for mediastinal staging of lung cancer: which SUV threshold makes sense? J Nucl Med. 2007;48:1761–6.CrossRefPubMed
14.
go back to reference Matthies A, Hickeson M, Cuchiara A, Alavi A. Dual time point 18F-FDG PET for the evaluation of pulmonary nodules. J Nucl Med. 2002;43:871–5.PubMed Matthies A, Hickeson M, Cuchiara A, Alavi A. Dual time point 18F-FDG PET for the evaluation of pulmonary nodules. J Nucl Med. 2002;43:871–5.PubMed
15.
go back to reference Hart ES, Kelly MH, Brillante B, Chen CC, Ziran N, Lee JS, et al. Onset, progression, and plateau of skeletal lesions in fibrous dysplasia and the relationship to functional outcome. J Bone Miner Res. 2007;22:1468–74.CrossRefPubMed Hart ES, Kelly MH, Brillante B, Chen CC, Ziran N, Lee JS, et al. Onset, progression, and plateau of skeletal lesions in fibrous dysplasia and the relationship to functional outcome. J Bone Miner Res. 2007;22:1468–74.CrossRefPubMed
16.
go back to reference Terpstra L, Rauch F, Plotkin H, Travers R, Glorieux FH. Bone mineralization in polyostotic fibrous dysplasia: histomorphometric analysis. J Bone Miner Res. 2002;17:1949–53.CrossRefPubMed Terpstra L, Rauch F, Plotkin H, Travers R, Glorieux FH. Bone mineralization in polyostotic fibrous dysplasia: histomorphometric analysis. J Bone Miner Res. 2002;17:1949–53.CrossRefPubMed
17.
go back to reference Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med. 1992;33:1972–80.PubMed Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med. 1992;33:1972–80.PubMed
18.
go back to reference Goodin GS, Shulkin BL, Kaufman RA, McCarville MB. PET/CT characterization of fibroosseous defects in children: 18F-FDG uptake can mimic metastatic disease. AJR Am J Roentgenol. 2006;187:1124–8.CrossRefPubMed Goodin GS, Shulkin BL, Kaufman RA, McCarville MB. PET/CT characterization of fibroosseous defects in children: 18F-FDG uptake can mimic metastatic disease. AJR Am J Roentgenol. 2006;187:1124–8.CrossRefPubMed
19.
go back to reference Toba M, Hayashida K, Imakita S, Fukuchi K, Kume N, Shimotsu Y, et al. Increased bone mineral turnover without increased glucose utilization in sclerotic and hyperplastic change in fibrous dysplasia. Ann Nucl Med. 1998;12:153–5.CrossRefPubMed Toba M, Hayashida K, Imakita S, Fukuchi K, Kume N, Shimotsu Y, et al. Increased bone mineral turnover without increased glucose utilization in sclerotic and hyperplastic change in fibrous dysplasia. Ann Nucl Med. 1998;12:153–5.CrossRefPubMed
20.
go back to reference Sahlmann CO, Siefker U, Meller J. Dual time point 2-[18F]fluoro-20-deoxyglucose positron emission tomography in chronic bacterial osteomyelitis. Nucl Med Commun. 2004;25:819–23.CrossRefPubMed Sahlmann CO, Siefker U, Meller J. Dual time point 2-[18F]fluoro-20-deoxyglucose positron emission tomography in chronic bacterial osteomyelitis. Nucl Med Commun. 2004;25:819–23.CrossRefPubMed
21.
go back to reference Israel O, Goldberg A, Nachtigal A, Militianu D, Bar-Shalom R, Keidar Z, et al. FDG-PET and CT patterns of bone metastases and their relationship to previously administered anti-cancer therapy. Eur J Nucl Med Mol Imaging. 2006;33:1280–4.CrossRefPubMed Israel O, Goldberg A, Nachtigal A, Militianu D, Bar-Shalom R, Keidar Z, et al. FDG-PET and CT patterns of bone metastases and their relationship to previously administered anti-cancer therapy. Eur J Nucl Med Mol Imaging. 2006;33:1280–4.CrossRefPubMed
22.
go back to reference Nakai T, Okuyamal C, Kubota T, Yamada K, Ushijima Y, Taniike K, et al. Pitfalls of FDG-PET for the diagnosis of osteoblastic bone metastases in patients with breast cancer. Eur J Nucl Med Mol Imaging. 2005;32:1253–8.CrossRefPubMed Nakai T, Okuyamal C, Kubota T, Yamada K, Ushijima Y, Taniike K, et al. Pitfalls of FDG-PET for the diagnosis of osteoblastic bone metastases in patients with breast cancer. Eur J Nucl Med Mol Imaging. 2005;32:1253–8.CrossRefPubMed
Metadata
Title
Recognition of fibrous dysplasia of bone mimicking skeletal metastasis on 18F-FDG PET/CT imaging
Authors
Ming Gang Su
Rong Tian
Qiu Ping Fan
Ye Tian
Fang Lan Li
Lin Li
An Ren Kuang
John Howard Miller
Publication date
01-03-2011
Publisher
Springer-Verlag
Published in
Skeletal Radiology / Issue 3/2011
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-010-0999-9

Other articles of this Issue 3/2011

Skeletal Radiology 3/2011 Go to the issue

Test Yourself: Question

Knee pain after falling