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FDG PET/CT appearance of local osteosarcoma recurrences in pediatric patients

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Abstract

Background

Osteosarcoma is the most common pediatric malignant bone tumor, frequently surgically managed with limb salvage rather than amputation. Local recurrences are seen in up to 9% of osteosarcoma patients, with CT and MRI imaging often limited by metal artifacts.

Objective

To describe the [F-18]2-fluoro-2-deoxyglucose (FDG) PET/CT appearance of local osteosarcoma recurrences with correlation to findings on other imaging modalities.

Materials and methods

A retrospective review of pediatric osteosarcoma patients imaged with FDG PET/CT was performed in patients with pathologically proven local recurrences. FDG PET/CT findings were reviewed and correlated with available comparison imaging studies.

Results

Ten local osteosarcoma recurrences in eight pediatric osteosarcoma patients were imaged with FDG PET/CT. All eight patients had a local recurrence after limb salvage; two patients had a second local recurrence after amputation. All local recurrences were seen with FDG PET/CT, demonstrating solid (n=5) or peripheral/nodular (n=5) FDG uptake patterns. Maximum standard uptake values (SUVs) ranged from 3.0 to 15.7. In five recurrences imaged with FDG PET/CT and MRI, MRI was limited or nondiagnostic in three. In four recurrences imaged with FDG PET/CT and bone scan, the bone scan was negative in three.

Conclusion

Local osteosarcoma recurrences are well visualized by FDG PET/CT, demonstrating either solid or peripheral/nodular FDG uptake with a wide range of maximum SUVs. FDG PET/CT demonstrates the full extent of local recurrences, while MRI can be limited by artifact from metallic hardware. PET/CT appears to be more sensitive than bone scan in detecting local osteosarcoma recurrences.

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Authors and Affiliations

  1. Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA

    Susan E. Sharp & Michael J. Gelfand

  2. Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Barry L. Shulkin & M. Beth McCarville

Authors
  1. Susan E. Sharp
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  2. Barry L. Shulkin
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  3. Michael J. Gelfand
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  4. M. Beth McCarville
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Correspondence to Susan E. Sharp.

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Sharp, S.E., Shulkin, B.L., Gelfand, M.J. et al. FDG PET/CT appearance of local osteosarcoma recurrences in pediatric patients. Pediatr Radiol 47, 1800–1808 (2017). https://doi.org/10.1007/s00247-017-3963-1

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  • DOI: https://doi.org/10.1007/s00247-017-3963-1

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