Detection of bone metastases: Assessment of integrated FDG PET/CT imaging

Purpose: To retrospectively evaluate the positive predictive value (PPV) of fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in the identification of malignant bone lesions when the PET and CT findings are discordant and concordant. Materials and Methods: The study conformed to HIPAA standards, and the need for informed consent was waived by the institutional review board that approved the study. FDG PET/CT reports of 712 patients were reviewed to identify patients with malignant bone lesions. Fifty-nine patients (30 female and 29 male patients; age range, 10 - 82 years) with 113 lesions were analyzed. With use of confirmation from histopathologic examination or clinical follow-up, the PPVs of the integrated examination and of the stand-alone CT and PET components of the examination were calculated. The results were stratified according to cancer type, chemotherapy status, and number of bone lesions and were compared by using Fisher exact tests. Results: Of 47 lesions with positive findings at both PET and CT, 46 were malignant and one was benign, for a PPV of 98%. Of 31 lesions with positive findings at PET and negative findings at CT, 19 were malignant and 12 were benign, for a PPV of 61%. Of 35 lesions with negative findings at PET and positive findings at CT, six were malignant and 29 were benign, for a PPV of 17%. Independently, the PPV of all lesions with positive findings at PET was significantly higher than that of all lesions with positive findings at CT. Chemotherapy status for lesions with positive findings at CT and the number of lesions per patient had a statistically significant effect on the PPV of examinations (P = .02 and P < .001, respectively). Conclusion: PET/CT has a very high PPV for bone metastases (98%) when the findings at PET and CT are concordant; however, in lesions with discordant PET and CT findings at the integrated examination, PPV is markedly diminished.