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Review ArticleCASE REVIEW: TEACHING FILES

18F-FDG PET/CT and 99mTc-MDP Imaging of Non–Small Cell Lung Carcinoma Osseous Metastases

Maria Komissarova, Ka Kit Wong and Lorraine M. Fig
Journal of Nuclear Medicine Technology March 2012, 40 (1) 66-67; DOI: https://doi.org/10.2967/jnmt.111.101956
Maria Komissarova
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Ka Kit Wong
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Lorraine M. Fig
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A 74-y-old male smoker presented with hemoptysis and was diagnosed with non–small cell lung cancer causing postobstructive pneumonia. He complained of lower back pain. A PET/CT scan was ordered to stage his disease. Sixty minutes after intravenous administration of 595.7 MBq (16.1 mCi) of 18F-FDG, sequential unenhanced CT and then PET images were acquired:

Figure

QUESTION 1

Based on the 18F-FDG PET/CT images, which of the following statements best describes the findings in the skeleton:

  • A. Multiple traumatic fractures.

  • B. Multiple metabolically active osseous metastases.

  • C. Lesions that cannot be characterized and are most likely degenerative disease.

  • D. Bone marrow stimulation.

One week later, a bone scan was performed to evaluate if 89Sr could be used to manage the patient’s intractable lower back pain. A whole-body bone scan was obtained 2 h after intravenous injection of 925 MBq (25 mCi) of 99mTc-methyldiphosphonate (99mTc-MDP):

Figure

QUESTION 2

Based on the anterior and posterior whole-body bone scan images, and considering the prior PET/CT scans, which of the following statements is true (Note: there is a history of trauma to the right ankle):

  • A. The bone scan appearance is expected because 18F-FDG PET is more sensitive than bone scanning for detection of osteoblastic metastases.

  • B. The discrepancy between the bone scan and 18F-FDG findings is most consistent with a benign process.

  • C. 18F-FDG PET allows earlier detection of metabolically active metastases in marrow that may not yet have generated an osseous response.

  • D. Bone scintigraphy is generally an insensitive modality for staging lung cancer skeletal metastases.

CASE DISCUSSION

In this patient with non–small cell lung cancer, 18F-FDG PET and 99mTc-MDP bone scintigraphy were strikingly discrepant for visualization of skeletal metastases. Although the literature shows varying results, the consensus is that 18F-FDG PET and 99mTc-MDP bone scintigraphy have equivalent sensitivity (∼90%), with 18F-FDG PET having the higher specificity (98% vs. 61% in 1 study).

The 2 agents show different sensitivities in osteoblastic versus osteolytic skeletal metastases, based on the mechanisms of tracer localization. 18F-FDG uptake represents increased glucose metabolism in malignant cells, whereas diphosphonate uptake reflects the remodeling response surrounding the metastatic deposits, which may take longer to develop. 18F-FDG PET thus potentially has an advantage for detection of early bone disease. Several authors have shown that 18F-FDG PET is more sensitive in detecting osteolytic metastases than bone scintigraphy, whereas bone scintigraphy is more sensitive in detecting osteoblastic metastases. This suggests a complementary role for 18F-FDG PET and bone scintigraphy depending on the predominate type of bone metastases expected.

Footnotes

  • Published online Jan. 25, 2012.

  • ↵* For the answers, see page 70

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Journal of Nuclear Medicine Technology: 40 (1)
Journal of Nuclear Medicine Technology
Vol. 40, Issue 1
March 1, 2012
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18F-FDG PET/CT and 99mTc-MDP Imaging of Non–Small Cell Lung Carcinoma Osseous Metastases
Maria Komissarova, Ka Kit Wong, Lorraine M. Fig
Journal of Nuclear Medicine Technology Mar 2012, 40 (1) 66-67; DOI: 10.2967/jnmt.111.101956
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18F-FDG PET/CT and 99mTc-MDP Imaging of Non–Small Cell Lung Carcinoma Osseous Metastases
Maria Komissarova, Ka Kit Wong, Lorraine M. Fig
Journal of Nuclear Medicine Technology Mar 2012, 40 (1) 66-67; DOI: 10.2967/jnmt.111.101956

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