Nucl Med Mol Imaging.  2011 Sep;45(3):203-211.

Evaluation of Bone Metastasis from Hepatocellular Carcinoma Using 18F-FDG PET/CTand 99mTc-HDP Bone Scintigraphy: Characteristics of Soft Tissue Formation

Affiliations
  • 1Division of Nuclear Medicine, Department of Radiology, Yonsei University College of Medicine, Seongsanno250, Seodaemun-gu, Seoul 120-752, Korea. mdkwj@yuhs.ac
  • 2Division of Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Bone metastasis from hepatocellular carcinoma (HCC) can present with soft tissue formation, resulting in oncologic emergency. Contrast-enhanced FDG PET/CT and bone scintigraphy were compared to evaluate characteristics of bone metastases with or without soft tissue formation from HCC.
METHODS
Of 4,151 patients with HCC, 263 patients had bone metastases. Eighty-five patients with bone metastasis from HCC underwent contrast-enhanced FDG PET/CT. Fifty-four of the enrolled subjects had recent 99mTc-HDP bone scintigraphy available for comparison. Metastatic bone lesions were identified with visual inspection on FDG PET/CT, and maximum standardized uptake value (SUVmax) was used for the quantitative analysis. Confirmation of bone metastasis was based on histopathology, combined imaging modalities, or serial follow-up studies.
RESULTS
Forty-seven patients (55%) presented with soft tissue formation, while the remaining 38 patients presented without soft tissue formation. Frequent sites of bone metastases from HCC were the spine (39%), pelvis (19%), and rib cage (14%). The soft-tissue-formation group had more frequent bone pain (77 vs. 37%, p<0.0001), higher SUVmax (6.02 vs. 3.52, p<0.007), and higher incidence of photon defect in bone scintigraphy (75 vs. 0%) compared to the non-soft-tissue-formation group. FDG PET/CT had higher detection rate for bone metastasis than bone scintigraphy both in lesion-based analysis (98 vs. 53%, p=0.0015) and in patient-based analysis (100 vs. 80%, p<0.001).
CONCLUSIONS
Bone metastasis from HCC showed a high incidence of soft tissue formation requiring emergency treatment. Although the characteristic findings for soft tissue formation such as photon defect in bone scintigraphy are helpful in detection, overall detectability of bone metastasis is higher in FDG PET/CT. Contrast-enhanced PET/CT will be useful in finding and delineating soft-tissue-forming bone metastasis from HCC.

Keyword

Hepatocellular carcinoma; Fluorodeoxyglucose; Positron emission tomography; Soft tissue formation; Bone metastasis

MeSH Terms

Carcinoma, Hepatocellular
Emergencies
Emergency Treatment
Fluorodeoxyglucose F18
Follow-Up Studies
Humans
Incidence
Neoplasm Metastasis
Pelvis
Positron-Emission Tomography
Ribs
Spine
Fluorodeoxyglucose F18
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