Case Study: 18F FDG PET-CT In Diagnosis And Pretreatment Staging Of Osteosarcoma

This case study highlights the utility of FDG PET-CT in simultaneous diagnosis as well as pretreatment whole body staging of osteosarcoma in a patient presenting with rapidly progressive hard knee swelling.

Patient Clinical History:

24 years old Male patient was referred by an orthopedician for evaluation of rapidly increasing bony hard swelling over the left knee joint for 18F FDG PET/CT scan.

Study Protocols:

PET CT scan was done following intravenous administration of 18F FDG on a PET scanner with Multidetector Computerized Tomography (MDCT), scanning was performed from Head to Feet. A separate CT sequence with breath hold was performed for lung and a dedicated thin slice series for brain examination.

Study Findings:

18F FDG PET/CT Scan MIP images revealed a large irregular intensely tracer avid mass along distal left femur (Fig 1. Black Arrow) and another discrete non-contiguous lesion along the mid shaft (Fig 2. Black Arrowhead). Rest of the body does not demonstrate any other obvious FDG avid abnormality.

CT and fused PET-CT images further demonstrate a hypermetabolic meta-diaphyseal lytic destructive mass lesion suspicious for primary mitotic etiology arising from distal left femur with associated significant infiltrating soft tissue component on corresponding axial soft tissue window (Fig 2a&b. white arrows), coronal soft tissue window (Fig 2c&d. white arrows) and coronal bone window (Fig 2e&f. white arrows) consistent with primary malignant bone etiology likely osteosarcoma.
Additionally, CT and fused PET-CT images also demonstrates another discrete non-contiguous hypermetabolic foci consistent with skip marrow lesion/metastases along mid femur as demonstrated in axial soft tissue window (Fig 3a&b. white arrows), axial bone window (Fig 3c&d. white arrows) and coronal soft tissue window (Fig 3e&f. white arrows).

A diagnosis of Osteosarcoma with skip lesion was then further confirmed using CT guided biopsy and MRI.

Additionally, FDG PET-CT was instrumental in effectively ruling out lung metastases providing valuable insights into disease management course, prognosis and expected long term outcomes.

Case Study Prepared by:

This 18F FDG PET-CT Scan case study was compiled by Dr. Aashish Gambhir [DRM, DNB] (Nuclear Medicine Physician at House Of Diagnostics Faridabad).

Read More about PET-MRI Scan at House Of Diagnostics in Delhi and NCR.

The Simultaneous PET-MRI Scan is currently offered at PET-Suite at Apollo Hospital, Sarita Vihar.

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