J Nucl Med 2002 Aug;43(8):1012-7
Prognostic Significance of (18)F-FDG and (99m)Tc-Methylene Diphosphonate
Uptake in Primary Osteosarcoma.
Franzius C, Bielack S, Flege S, Sciuk J, Jurgens H, Schober O.
The purpose of this retrospective analysis was to evaluate the prognostic
significance of both initial glucose metabolism as measured by (18)F-FDG PET and
osteoblastic activity as measured by (99m)Tc-methylene diphosphonate (MDP) bone
scintigraphy in osteosarcoma. METHODS: In 29 patients (18 male, 11 female; age
range, 5-41 y) with primary osteosarcoma, (18)F-FDG uptake and (99m)Tc-MDP
uptake were measured semiquantitatively (average and maximum tumor-to-nontumor
ratios [T/NT(av) and T/NT(max), respectively]) using PET and bone scintigraphy
at the time of diagnosis. After chemotherapy, the patients underwent surgery for
their primary tumor, and the response was determined histologically. Cumulative
overall survival and event-free survival were determined by clinical and imaging
follow-up of 7-72 mo (median, 28 mo). RESULTS: Clinical and imaging follow-up
revealed that the disease relapsed or failed to achieve complete remission in 9
patients and that 6 patients died of the disease. Both overall and event-free
survival were significantly better in patients with a low (18)F-FDG T/NT(max)
(less than the median) than in patients with a high (18)F-FDG T/NT(max) (at
least the median). The negative relationship of (18)F-FDG T/NT(av), (99m)Tc-MDP
T/NT(max), and (99m)Tc-MDP T/NT(av) with overall and event-free survival did not
reach a level of significance. (18)F-FDG uptake values correlated moderately and
positively with (99m)Tc-MDP uptake values, but a level of significance was
reached only between (18)F-FDG T/NT(max) and (99m)Tc-MDP T/NT(av). CONCLUSION:
The initial glucose metabolism of primary osteosarcoma as measured by (18)F-FDG
PET using T/NT(max) provides prognostic information. High (18)F-FDG uptake
correlates with poor outcome. Thus, (18)F-FDG uptake may be complementary to
other well-known factors in judging the prognosis in osteosarcoma.
