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Glucose metabolic analysis of musculoskeletal tumours using 18fluorine-FDG PET as an aid to preoperative planning

H. Watanabe, MD, DMSc, Lecturer1; T. Shinozaki, MD, DMSc, Assistant1; T. Yanagawa, MD, Graduate Student1; J. Aoki, MD, DMSc, Associate Professor2; M. Tokunaga, MD, Graduate Student2; T. Inoue, MD, DMSc, Associate Professor3; K. Endo, MD, DMSc, Director Professor3; S. Mohara, MD, DMSc, Professor4; K. Sano, MD, Hospital President5; and K. Takagishi, MD, DMSc, Director Professor1

1 Department of Orthopaedic Surgery
2 Department of Diagnostic Radiology
3 Department of Nuclear Medicine
4 Department of Physical Therapy, Gunma University Faculty of Medicine, 3-39-15 Showa, Maebashi, Gunma 371-8511, Japan.
5 Department of Orthopaedic Surgery, Toho Hospital, Kasagake, Nitta-Gun, Gunma 379-23, Japan.

Correspondence should be sent to Dr H. Watanabe.

We performed positron emission tomography (PET) with 18fluorine-fluoro-2-deoxy-D-glucose (FDG) on 55 patients with tumours involving the musculoskeletal system in order to evaluate its role in operative planning. The standardised uptake value (SUV) of FDG was calculated and, to distinguish malignancies from benign lesions, the cases were divided into high (≥ 1.9) and low (< 1.9) SUV groups.

The sensitivity of PET for correctly diagnosing malignancy was 100% with a specificity of 76.9% and an overall accuracy of 83.0%. The mean SUV for metastatic lesions was twice that for primary sarcomas (p < 0.0015).

Our results suggest that the SUV may be useful in differentiating malignant tumours from benign lesions. However, some of the latter, such as schwannomas, had high SUVs so that biopsy or wide resection was selected as the first operation. Thus, some other quantitative analysis may be required for preoperative planning in cases of high-SUV neurogenic benign tumours. The reverse transcription-polymerase chain reaction revealed that the RNA message of a key enzyme in glucose metabolism, phosphohexose isomerase (PHI)/autocrine motility factor, was augmented in only high FDG-uptake lesions, suggesting that a high expression of the PHI message may be associated with accumulation of FDG in musculoskeletal tumours.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General