Benign versus malignant intraosseous lesions: Discrimination by means of PET with 2-[F-18]fluoro-2-deoxy-D-glucose

PURPOSE: To assess the ability of positron emission tomography (PET) with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) to allow differentiation of benign from malignant intraosseous lesions. MATERIALS AND METHODS: Twenty patients with strictly intraosseous lesions (five benign and 15 malignant [three primary and 12 metastatic]) were studied with FDG PET. The final diagnosis was confirmed with histopathologic examination in all patients. The uptake of FDG within each lesion was evaluated qualitatively as well as semiquantitatively by determination of the standardized uptake value (SUV). RESULTS: SUV assessment of FDG accumulation within osseous lesions was superior to subjective visual analysis for discriminating benign from malignant lesions. With use of a 2.0 cutoff value for SUV, 14 of 15 malignant lesions were categorized correctly versus 12 of 15 correctly categorized by means of subjective image evaluation; four of five benign lesions were categorized correctly with both techniques. CONCLUSION: FDG PET can aid in differentiating benign from malignant strictly intraosseous lesions.