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Is There a Need for Dedicated Bone Imaging in Addition to 18F-FDG PET/CT Imaging in Pediatric Sarcoma Patients?

Walter, Franziska MD; Czernin, Johannes MD; Hall, Theodore MD; Allen-Auerbach, Martin MD; Walter, Martin A. MD; Dunkelmann, Simone MD; Federman, Noah MD

Journal of Pediatric Hematology/Oncology: March 2012 - Volume 34 - Issue 2 - p 131–136
doi: 10.1097/MPH.0b013e3182282825
Original Articles

Purpose: Many children with sarcomas undergo whole body 2-deoxy-2-(18F)fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) and technetium methylene diphosphonate (99Tc-MDP) studies. It is unknown whether the combination of both tests results in more accurate detection of bone lesions than 18F-FDG- PET/CT alone.

Methods: 99Tc-MDP bone and 18F-FDG PET/CT scans were each read by 2 “blinded” observers and then reviewed side-by-side by 3 readers. Bone lesions were graded qualitatively on a 5-point scale (from benign to malignant). Clinical and imaging follow-up (n=21) and bone biopsy results (n=8) served as reference standard.

Results: A total of 39 paired 99Tc-MDP and 18F-FDG-PET/CT studies (cases) performed at a mean interval 4±7 days, were performed on 29 patients (mean age 12±5 y). Of these, 21 patients (72%) had bone sarcoma, whereas 8 patients (28%) had soft tissue sarcoma. By patient and case-based analysis, 18F-FDG PET/CT had an accuracy of 100%. 99Tc-MDP had accuracies of 90% and 82% by patient and case-based analysis. The combined interpretation had an accuracy of 97%.

Conclusions: In this study, 99Tc-MDP bone imaging does not provide an added diagnostic value for bone involvement over 18F-FDG-PET/CT.

*Department of Molecular and Medical Pharmacology, University of California Los Angeles

Ahmanson Translational Imaging Division

Department of Radiology, David Geffen School of Medicine at UCLA

§Institute of Nuclear Medicine, University Hospital Basel

Institute of Nuclear Medicine, University Hospital Rostock

Department of Pediatrics, Division of Hematology/Oncology, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA

The authors declare no conflict of interest.

Reprints: Noah Federman, MD, Department of Pediatrics, Hematology/Oncology UCLA Mattel Children's Hospital, 10833 Le Conte Avenue, A2-410 MDCC, Los Angeles, CA 90095 (e-mail:

Received February 16, 2011

Accepted June 7, 2011

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.