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Skeletal Muscle Metastases on FDG PET/CT Imaging

Khandelwal, Alok R. PhD*; Takalkar, Amol M. MD*†; Lilien, David L. MD*†; Ravi, Ajay MD

doi: 10.1097/RLU.0b013e3182443e32
Original Articles

Background Skeletal muscle metastases (SMM) are a rare occurrence despite the fact that skeletal muscle comprises more than 50% of total body mass. When present, most are asymptomatic and are often found incidentally on imaging. Several studies have reported isolated cases of patients with SMM. The goal of our study was to perform a comprehensive retrospective analysis of the incidence, frequency, and source of SMM in patients with malignancies who underwent whole-body FDG PET/CT imaging for the workup for their malignancy.

Methods The records of 8492 consecutive patients referred for oncologic imaging at our institution during the period from January 2006 to December 2009 were reviewed. Patients who had SMM on FDG PET imaging were further assessed for collaborating evidence on other imaging modalities, pathology from tissue sampling, and follow-up scans. The incidence of SMM in our setting was calculated, and their association with various primary malignancies was also evaluated.

Results A total of 73 patients with SMM were identified on PET/CT imaging (incidence, 0.86%). Lung cancer was the most frequent source (25 patients [34%]), followed by gastrointestinal tract malignancies (13 patients [18%]), breast cancer (10 patients [14%]), genitourinary malignancies and lymphoma (6 patients [8%] each), melanoma (5 patients [7%]), and other miscellaneous malignancies (3 patients [4%]). Primary source remained unknown in only 5 patients (7%). Most patients with SMM generally had markedly widespread involvement which led to an unusual appearance on FDG PET/CT imaging. However, since most of these patients had stage IV malignant disease by virtue of visceral metastases elsewhere as well, they were generally not upstaged.

Conclusions Our study confirmed the rare occurrence of SMM. Furthermore, FDG PET/CT can potentially detect unsuspected SMM. Interestingly, in our patient population, lung cancer was found to be the most frequent malignancy metastasizing to the skeletal muscles. Knowledge about the presence and appearance of widespread SMM may aid in appropriate interpretation of FDG PET/CT scans.

From the *PET Imaging Center, Biomedical Research Foundation of Northwest Louisiana, Shreveport, LA; and †Department of Radiology, Louisiana State University Health Sciences Center–Shreveport, Shreveport, LA.

Received for publication July 28, 2011; revision accepted October 18, 2011.

Conflicts of interest and sources of funding: none declared.

Reprints: Amol M. Takalkar, MD, PET Imaging Center, Biomedical Research Foundation of Northwest Louisiana, 1505 Kings Highway, Shreveport, LA 71105. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.