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Cheon, Choe, Chae, Lee, Song, Kim, and Park: FDG-PET/CT Complements Bone Scan with Respect to the Detection of Skip Metastasis of Osteosarcoma: A Case Report
Case Report
The Journal of the Korean Bone and Joint Tumor Society

The Journal of the Korean Bone and Joint Tumor Society 2012; 18(1): 45-49.

Published online: 27 June 2012

DOI: https://doi.org/10.5292/jkbjts.2012.18.1.45

FDG-PET/CT Complements Bone Scan with Respect to the Detection of Skip Metastasis of Osteosarcoma: A Case Report

Gi Jeong Cheon, M.D.*, Jae Gol Choe, M.D.*, In Jung Chae, M.D., Dae Hee Lee, M.D., Sang Heon Song, M.D., Myo Jong Kim, M.D., Jong Hoon Park, M.D.

Department of Orthopedic Surgery, Korea University Hospital, Seoul, Korea.

*Department of Nuclear Medicine, Korea University Hospital, Seoul, Korea.

Correspondence to: Jong Hoon Park, M.D. Department of Orthopedic Surgery, Korea University Hospital, 126-1, Anamdong 5-ga, Seongbuk-gu, Seoul 136-705, Korea. TEL: +82-2-920-6609, FAX: +82-2-924-2471, pjh1964@hanmail.net

Received 2 March 2012       Revised 28 May 2012       Accepted 30 May 2012

Copyright © 2012 by The Korean Bone and Joint Tumor Society

(open-access):

"This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited."

Abstract

Skip lesion is not uncommon feature in osteosarcoma and considered to be importantly associated with poor prognosis factor, and thus, should be excised with the main mass. The accurate pre-operative evaluation of the intramedullary extent of osteosarcoma is essential, because it determines the level of bone resection. Among the reliable detection methods, bone scan has a drawback of high rate of false negative results and regional MRI has a difficulty to cover the whole involved lesions without clinical suspicion. The authors report a case of osteosarcoma of the distal femur with a proximal skip lesion that was not detected by either regional MR imaging or by bone scan, but which was visualized by FDG-PET/CT.

Keywords: skip metastasis, osteosarcoma, F-18 FDG-PET/CT, bone scintigraphy (BS)

Figures and Tables

Figure 1
Plain radiographs show an osteolytic lesion of a medial aspect of distal femur in AP view.
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Figure 2
Coronal and sagittal T1-weighted MR image at presentation show an osteosarcoma extending approximately 10 cm from the distal femoral articular surface. There is some soft tissue extension in medial direction.
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Figure 3
Whole body bone scan at presentation showing isolated area of increased uptake in medial aspect of right distal femur. There is no suspected metastatic and skip lesion.
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Figure 4
MR imaging of Right femur at the time of pre-operative restaging examination. T1 coronal and sagittal image of whole femur showing the skip lesion in proximal diaphysis.
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Figure 5
Plain femur AP and Lat view showing no significant skip lesion of the proximal diaphysis.
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Figure 6
Initial FDG-PET scan and restaging PET scan also showing distinct skip lesion.
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References

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Gi Jeong Cheon
https://orcid.org/http://orcid.org/0000-0002-1360-5186

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