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CT Appearance of Bone Metastases Detected with FDG PET as Part of the Same PET/CT Examination¹

¹ From the Division of Nuclear Medicine, Johns Hopkins School of Medicine, 601 N Caroline St, Room 3223A, Baltimore, MD 21287-0817. Received December 8, 2003; revision requested February 12, 2004; final revision received December 9; accepted January 26, 2005. Address correspondence to R.L.W.

PURPOSE: To retrospectively evaluate lesion findings at computed tomography (CT) performed as part of a combined positron emission tomography (PET)/CT examination in patients suspected of having metastatic bone lesions—lesions that were detected with fluorine 18 fluorodeoxyglucose (FDG) PET as part of the same examination—and to correlate the CT and FDG PET findings.

MATERIALS AND METHODS: This HIPAA-compliant study had institutional review board approval, and the need for patient informed consent was waived. Three hundred fifty-nine consecutive patients (191 male patients, 168 female patients; mean age, 56.9 years; age range, 8–92 years) underwent PET/CT. PET images were first reviewed by nuclear medicine physicians who had no clinical information regarding the presence or absence of bone metastasis by using a five-point grading system (0, a lesion was definitely negative for metastasis; 1, a lesion was probably negative; 2, a lesion was equivocal; 3, a lesion was probably positive; and 4, a lesion was definitely positive). For lesions assigned a grade of 3 or 4 at PET, CT characteristics such as the presence or absence of morphologic changes or accompanying findings (including bone destruction) were assessed by radiologists on the CT images obtained during the same imaging session.

RESULTS: One hundred seventy-nine lesions in 55 patients were considered to be probable or definite bone metastases at PET. One hundred thirty-three of these lesions in 33 patients were clinically confirmed to be bone metastases at follow-up and/or histopathologic examination. CT revealed osteolytic changes in 41 (31%) and osteoblastic changes in 21 (16%) of the 133 lesions, but no or nonspecific changes were seen at CT in 49 (37%) and 22 lesions (17%), respectively. Of the 179 lesions suspected at PET, 46 ultimately proved to be nonosseous or false-positive for bone metastasis. Of these 46 lesions, 38 were not located in the bone but in adjacent tissues such as the pleura.

CONCLUSION: CT images obtained as part of PET/CT scanning were useful in yielding the precise location of bone lesions and thus helping avoid misdiagnosis of bone metastasis; however, CT revealed morphologic changes in only half of the lesions assigned a grade of 3 or 4 at PET.

© RSNA, 2005

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