alexa Fusion of metabolic function and morphology: sequential [18F]fluorodeoxyglucose positron-emission tomography computed tomography studies yield new insights into the natural history of bone metastases in breast cancer.


Journal of Cancer Science & Therapy

Author(s): Du Y, Cullum I, Illidge TM, Ell PJ

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Abstract PURPOSE: By monitoring bone metastases with sequential [(18)F]fluorodeoxyglucose positron-emission tomography/computed tomography ([(18)F]FDG-PET/CT) imaging, this study investigates the clinical relevance of [(18)F]FDG uptake features of bone metastases with various radiographic appearances. PATIENTS AND METHODS: Bone metastases were found in 67 of 408 consecutive patients with known/suspected recurrent breast cancer on [(18)F]FDG-PET/CT, characterized by CT morphology changes and/or bony [(18)F]FDG uptake. Twenty-five of the patients had sequential [(18)F]FDG-PET/CT examinations (86 studies) over an average follow-up period of 23 months. The temporal changes in [(18)F]FDG uptake and corresponding CT morphology features of 146 bone lesions identified in these 25 patients were followed up and correlated with therapeutic outcome retrospectively. RESULTS: The 146 lesions were classified as osteolytic (77), osteoblastic (41), mixed-pattern (11), or no change/negative (17) on CT. The majority of the osteolytic (72; 93.5\%) and mixed-pattern lesions (nine; 81.8\%), but fewer of the osteoblastic lesions (25; 61\%), showed increased [(18)F]FDG uptake. After treatment, 58 osteolytic lesions (80.5\%) became [(18)F]FDG negative and osteoblastic on CT and only 14 relatively large lesions (19.5\%) remained [(18)F]FDG avid. Of the 25 [(18)F]FDG-avid osteoblastic lesions, 13 (52\%) became [(18)F]FDG negative, but 12 (48\%) remained [(18)F]FDG avid and increased in size on CT. Five of the mixed-pattern lesions remained [(18)F]FDG avid after treatment. All 17 CT-negative lesions became [(18)F]FDG negative; however, nine of them became osteoblastic. None of the initially [(18)F]FDG-negative lesions showed [(18)F]FDG avidity during follow-up. CONCLUSION: [(18)F]FDG uptake reflects the immediate tumor activity of bone metastases, whereas the radiographic morphology changes vary greatly with time among patients. This article was published in J Clin Oncol and referenced in Journal of Cancer Science & Therapy

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