99mTc-DMSA (V) in Evaluation of Osteosarcoma: Comparative Studies with 18F-FDG PET/CT in Detection of Primary and Malignant Lesions

G P Bandopadhyaya,Archana Singh,Rakesh Kumar,Arun Malhotra,S Rastogi,Jaya Shukla,Priyanka Gupta

doi:10.5402/2012/371830

G P Bandopadhyaya, Archana Singh + Show 5 more

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https://doi.org/10.5402/2012/371830

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Abstract

To evaluate the role of 99mTc-DMSA (V) and [18F]FDG PET-CT in management of patients with osteosarcoma, 22 patients were included in our study. All patients underwent both 99mTc-DMSA (V) and whole-body [18F]FDG PET-CT scans within an interval of 1 week. 555–740 MBq of 99mTc-DMSA (V) was injected i.v. the whole-body planar, SPECT images of primary site and chest were performed after 3-4 hours. [18F]FDG PET-CT images were obtained 60 minutes after i.v. injection of 370 MBq of F-18 FDG. Both FDG PET-CT (mean SUVmax = 7.1) and DMSA (V) scans showed abnormal uptake at primary site in all the 22 patients (100% sensitivity for both). Whole-body PET-CT detected metastasis in 11 pts (lung mets in 10 and lung + bone mets in 1 patient). Whole-body planar DMSA (V) and SPECT detected bone metastasis in one patient, lung mets in 7 patients and LN in 1 patient. HRCT of chest confirmed lung mets in 10 patients and inflammatory lesion in one patient. 7 patients positive for mets on DMSA (V) scan had higher uptake in lung lesions as compared to FDG uptake on PET-CT. Three patients who did not show any DMSA uptake had subcentimeter lung nodule. Resuts of both 99mTc-DMSA (V) (whole-body planar and SPECT imaging) and [18F]FDG PET-CT were comparable in evaluation of primary site lesions and metastatic lesions greater than 1 cm. Though 99mTc-DMSA (V) had higher uptake in the lesions as compared to [18F]FDG PET-CT, the only advantage [18F]FDG PET-CT had was that it could also detect subcentimeter lesions.

Highlights

OS is a primary malignant bone tumor characterized by the direct formation of immature bone or osteoid tissue by the tumor cells
It usually metastasizes to the lungs and bones which is associated with poor prognosis
Pentavalent 99mTcDimercaptosuccinic acid appears to be a promising radiopharmaceutical for detecting primary and metastases in patients with osteosarcoma. 18F-FDG PETCT plays an important role in detecting primary and metastases in these patients

Summary

Introduction

OS is a primary malignant bone tumor characterized by the direct formation of immature bone or osteoid tissue by the tumor cells. It is thought to arise from primitive mesenchymal bone-forming cells. The classic OS is a rare (45% of all malignant bone tumors) highly malignant tumor [1, 2], with an estimated incidence of 3 cases/million population/year. OS arises predominantly in the metaphysis of long bones, the most common sites of involvement are femur (42%, 75% of which are distal femur), tibia (19%, 80% of which are proximal tibia), and humerus (10%, 90% of which are proximal humerus). Other significant locations are the skull and jaw (8%) and pelvis (8%). The age at presentation ranges from 10 to 25 years of age

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