Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jun 28, 2019; 11(6): 81-93
Published online Jun 28, 2019. doi: 10.4329/wjr.v11.i6.81
Positron emission tomography/computed tomography imaging appearance of benign and classic “do not touch” osseous lesions
Stacey M Elangovan, Ronnie Sebro
Stacey M Elangovan, Ronnie Sebro, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States
Ronnie Sebro, Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States
Ronnie Sebro, Department of Genetics, University of Pennsylvania, Philadelphia, PA 19104, United States
Ronnie Sebro, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, United States
Author contributions: Elangovan SM and Sebro R designed and performed the research and wrote the paper; Sebro R analyzed the data.
Institutional review board statement: The study was reviewed and approved by the local institutional review board and the need for signed informed consent for each participant was waived.
Informed consent statement: The study was reviewed and approved by the local institutional review board and the need for signed informed consent for each participant was waived.
Conflict-of-interest statement: The authors declare no conflicts of interest
Data sharing statement: Data available upon request from the senior author.
STROBE statement: The manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ronnie Sebro, MD, PhD, Assistant Professor, Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States. ronnie.sebro@uphs.upenn.edu
Telephone: +1-215-2949512 Fax: +1-215-6153316
Received: March 7, 2019
Peer-review started: March 11, 2019
First decision: April 16, 2019
Revised: May 11, 2019
Accepted: June 20, 2019
Article in press: June 21, 2019
Published online: June 28, 2019
Abstract
BACKGROUND

Classic “do not touch” and benign osseous lesions are sometimes detected on 18-F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) studies. These lesions are often referred for biopsy because the physician interpreting the PET/CT may not be familiar with the spectrum of 18F-FDG uptake patterns that these lesions display.

AIM

To show that “do not touch” and benign osseous lesions can have increased 18F-FDG uptake above blood-pool on PET/CT; therefore, the CT appearance of these lesions should dictate management rather than the standardized uptake values (SUV).

METHODS

This retrospective study evaluated 287 independent patients with 287 classic “do not touch” (benign cystic lesions, insufficiency fractures, bone islands, bone infarcts) or benign osseous lesions (hemangiomas, enchondromas, osteochondromas, fibrous dysplasia, Paget’s disease, osteomyelitis) who underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) at a tertiary academic healthcare institution between 01/01/2006 and 12/1/2018. The maximum and mean SUV, and the ratio of the maximum SUV to mean blood pool were calculated. Pearson’s correlations between lesion size and maximum SUV were calculated.

RESULTS

The ranges of the maximum SUV were as follows: For hemangiomas (0.95-2.99), bone infarcts (0.37-3.44), bone islands (0.26-3.29), enchondromas (0.46-2.69), fibrous dysplasia (0.78-18.63), osteochondromas (1.11-2.56), Paget’s disease of bone (0.93-5.65), insufficiency fractures (1.06-12.97) and for osteomyelitis (2.57-12.64). The range of the maximum SUV was lowest for osteochondromas (maximum SUV 2.56) and was highest for fibrous dysplasia (maximum SUV of 18.63). There was at least one lesion that demonstrated greater 18F-FDG avidity than the blood pool amongst each lesion type, with the highest maximum SUV ranging from 9.34 times blood pool mean (osteomyelitis) to 1.42 times blood pool mean (hemangiomas). There was no correlation between the maximum SUV and the lesion size except for enchondromas. Larger enchondromas had higher maximum SUV (r = 0.36, P = 0.02).

CONCLUSION

The classic “do not touch” lesions and classic benign lesions can be 18F-FDG avid. The CT appearance of these lesions should dictate clinical management rather than the maximum SUV.

Keywords: Positron emission tomography/computed tomography, Skeletal-axial, Skeletal-appendicular, “Do not touch” lesions

Core tip: Several benign and “do not touch” osseous lesions have 18F-FDG uptake above blood pool. Clinical management should be based on the CT appearance of these lesions rather than the maximum SUV uptake from PET/CT.