FDG PET of Primary Benign and Malignant Bone Tumors: Standardized Uptake Value in 52 Lesions

PURPOSE: To evaluate the standardized uptake value (SUV) of 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) at positron emission tomography (PET) in the differentiation of benign from malignant bone lesions.

MATERIALS AND METHODS: Fifty-two (19 malignant, 33 benign) primary bone lesions were examined with FDG PET prior to tissue diagnosis. The SUVs were calculated and compared between benign and malignant lesions and among histologic subgroups that included more than four cases.

RESULTS: There was a statistically significant difference in SUV between benign (2.18 ± 1.52 [SD]) and malignant (4.34 ± 3.19) lesions in total (P = .002). However, giant cell tumors (n = 5; SUV, 4.64 ± 1.05) showed significantly higher SUV than chondrosarcomas (n = 7; SUV, 2.23 ± 0.74) (P = .036, adjusted for multiple comparisons) and had no statistically significant difference in SUV compared with osteosarcomas (n = 6; SUV, 3.07 ± 0.96) (P = .171). There was no statistically significant difference in SUV between fibrous dysplasias (n = 6; SUV, 2.05 ± 0.98) and osteosarcoma (P = .127) or chondrosarcomas (P = .667). Although the number of cases was small, three chondroblastomas, one sarcoidosis, and one Langerhans cell histiocytosis showed levels of FDG accumulation as high as that of osteosarcomas.

CONCLUSION: Radiologists should be aware of the high accumulation of FDG in some benign bone lesions, especially histiocytic or giant cell–containing lesions. Consideration of histologic subtypes should be included in analysis of SUV at FDG PET of primary bone tumors.


  • 1 Strauss LG, Conti PS. The applications of PET in oncology. J Nucl Med 1991; 32:623-648. MedlineGoogle Scholar
  • 2 Hoh CK, Schiepers C, Seltzer MA, et al. PET in oncology: will it replace the other modalities?. Semin Nucl Med 1997; 27:94-106. Crossref, MedlineGoogle Scholar
  • 3 Brock CS, Meikle SR, Price P. Dose fluorine-18 fluorodeoxy glucose metabolic imaging of tumors benefit oncology?. Eur J Nucl Med 1997>/DATE>; 24:691-705. Crossref, MedlineGoogle Scholar
  • 4 Kern KA, Brunetti A, Norton JA, et al. Metabolic imaging of human extremity musculoskeletal tumors by PET. J Nucl Med 1988; 29:181-186. MedlineGoogle Scholar
  • 5 Adler LP, Blair HF, Makley JT, et al. Noninvasive grading of musculoskeletal tumors using PET. J Nucl Med 1991; 32:1508-1512. MedlineGoogle Scholar
  • 6 Griffeth LK, Dehdashti FD, McGire AH, et al. PET evaluation of soft-tissue masses with fluorine-18 fluoro-2-deoxy-d-glucose. Radiology 1992; 182:185-194. LinkGoogle Scholar
  • 7 Dehdashti FD, Siegel GA, Griffeth LK, et al. Benign versus malignant intraosseous lesions: discrimination by means of PET with 2-[F-18]fluoro-2-deoxy-d-glucose. Radiology 1996; 200:243-247. LinkGoogle Scholar
  • 8 Kole AC, Nieweg OE, Hoekstra HJ, van Horn JR, Koops HS, Vaalburg W. Fluorine-18-fluorodeoxyglucose assessment of glucose metabolism in bone tumors. J Nucl Med 1998; 39:810-815. MedlineGoogle Scholar
  • 9 Guhlmann A, Brechy-Krauss D, Suger G, et al. Chronic osteomyelitis: detection with FDG PET and correlation with histopathologic findings. Radiology 1998; 206:749-754. LinkGoogle Scholar
  • 10 Palmer WE, Rosenthal DI, Schoenberg OI, et al. Quantification of inflammation in the wrist with gadolinium-enhanced MR imaging and PET with 2-[F-18]-fluoro-2-deoxy-d-glucose. Radiology 1995; 196:647-655. LinkGoogle Scholar
  • 11 Hamacher K, Coenen HH, Stocklin G. Efficient stereospecific synthesis of non-carrier-added 2-[18F]-fluoro-2-deoxy-d-glucose using aminopolyether supported nucleophilic substitution. J Nucl Med 1986; 27:235-238. MedlineGoogle Scholar
  • 12 Zasadny KR, Wahl RL. Standardized uptake values of normal tissues at PET with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose: variations with body weight and a method for correction. Radiology 1993; 189:847-850. LinkGoogle Scholar
  • 13 Meikle SR, Bailey DL, Hooper PK, et al. Simultaneous emission and transmission measurement for attenuation correction in whole-body PET. J Nucl Med 1995; 36:1680-1688. MedlineGoogle Scholar
  • 14 Inoue T, Kim EE, Komaki R, et al. Detecting recurrent or residual lung cancer with PET-FDG. J Nucl Med 1995; 36:788-793. MedlineGoogle Scholar
  • 15 Johnston J. Giant cell tumor of bone: the role of the giant cell in orthopedic pathology. Orthop Clin North Am 1977; 8:751-770. Crossref, MedlineGoogle Scholar
  • 16 Ling L, Klein MJ, Sissons HA, Steiner GC, Winchester RJ. Expression of Ia and monocyte-macrophage lineage antigens in giant cell tumor of bone and related lesions. Arch Pathol Lab Med 1988; 112:65-69. MedlineGoogle Scholar
  • 17 Meszaros K, Lang CH, Bagby GJ, Spitzer JJ. Contribution of different organs to increased glucose consumption after endotoxin administration. J Biol Chem 1987; 262:10965-10970. Crossref, MedlineGoogle Scholar
  • 18 Gamelli RL, Liu H, He L, Hofmann CA. Augmentation of glucose transporter-1 in macrophages following thermal injury and sepsis in mice. J Leukoc Biol 1996; 59:639-647. Crossref, MedlineGoogle Scholar
  • 19 Brudin LH, Valid SO, Rhodes CG, et al. Fluorine-18 deoxyglucose uptake in sarcoidosis measured with positron emission tomography. Eur J Nucl Med 1994; 21:297-305. Crossref, MedlineGoogle Scholar
  • 20 Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med 1992; 33:1972-1980. MedlineGoogle Scholar
  • 21 Brudin LH, Valid SO, Rhodes CG, et al. Fluorine-18 deoxyglucose uptake in sarcoidosis measured with positron emission tomography. Eur J Nucl Med 1994; 21:297-305. Crossref, MedlineGoogle Scholar
  • 22 Yamada Y, Uchida Y, Tatsumi K, et al. Fluorine-18-fluorodeoxyglucose and carbon-11-methionine evaluation of lymphadenopathy in sarcoidosis. J Nucl Med 1998; 39:1160-1166. MedlineGoogle Scholar
  • 23 Cook GRC, Fogelman I, Maisey MN. Normal physiological and benign pathological variants of 18-fluoro-2-deoxyglucose positron-emission tomography scanning: potential for error in interpretation. Semin Nucl Med 1996; 26:308-314. Crossref, MedlineGoogle Scholar
  • 24 Raisz LG, Rodan GA. Cellular basis for bone turnover. In: Avioli LV, Krane SM, eds. Metabolic bone disease and clinically related disorders. 2nd ed. Philadelphia, Pa: Saunders, 1990; 1-41. Google Scholar
  • 25 Dahlin DC, Unni KK. Bone tumors: general aspects and data on 8,542 cases 4th ed. Springfield, Ill: Thomas, 1986; 413-420. Google Scholar
  • 26 Kubota K, Kubota R, Yamada S. FDG accumulation in tumor tissue (editorial). J Nucl Med 1993; 34:419-421. MedlineGoogle Scholar

Article History

Published in print: June 2001