Prevalence of exclusive lower extremity metastases at <sup>18</sup>F-NaF PET/CT

Ordones, Monique Beraldo; Valadares, Agnes Araujo; Duarte, Paulo Schiavom; Sado, Heitor Naoki; Lima, Marcos Santos; Carvalho, Giovanna; Sapienza, Marcelo Tatit; Buchpiguel, Carlos Alberto

doi:10.1590/0100-3984.2014.0053

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ORIGINAL ARTICLES • Radiol Bras 48 (3) • May-Jun 2015 • https://doi.org/10.1590/0100-3984.2014.0053 copy

Prevalence of exclusive lower extremity metastases at ¹⁸F-NaF PET/CT^* * Study developed at Service of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp) and at the Center of Nuclear Medicine, Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To evaluate the prevalence of exclusive lower extremity metastases, specifically in the femur and below the knee, observed at ¹⁸F-NaF PET/CT.

Materials and Methods:

One thousand consecutive PET/CT studies were retrospectively evaluated for the presence of exclusive uptake in lower extremities suggesting metastatic involvement. The presumptive diagnoses based on such uptakes were subsequently obtained by evaluation of other imaging studies.

Results:

No exclusive uptake suggestive of metastasis below the femur was observed in the present series. Exclusive uptake was observed in the proximal femur with a presumptive diagnosis of metastasis in two patients.

Conclusion:

The prevalence of exclusive metastasis below the femur is low and scanning from head to knees is appropriate in most cases.

Keywords:
PET/CT; ¹⁸F-NaF; Scintigraphy; Bone; Metastasis

Authorship

Monique Beraldo Ordones Mailing Address: Dra. Monique Beraldo Ordones. Instituto do Câncer do Estado de São Paulo – Setor de Medicina Nuclear. Avenida Doutor Arnaldo, 251, Sumaré. São Paulo, SP, Brazil, 01255-000. E-mail: moniqueordones@yahoo.com.br.

MD, Resident, Center of Nuclear Medicine, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HCFMUSP), São Paulo, SP, Brazil.Universidade de São PauloBrazilSão Paulo, SP, BrazilMD, Resident, Center of Nuclear Medicine, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HCFMUSP), São Paulo, SP, Brazil.

Agnes Araujo Valadares

Nuclear Medicine Physician at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil.Universidade de São PauloBrazilSão Paulo, SP, BrazilNuclear Medicine Physician at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil.

Paulo Schiavom Duarte

PhDs, Physician Assistants, Service of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil.Instituto do Câncer do Estado de São Paulo Octavio Frias de OliveiraBrazilSão Paulo, SP, BrazilPhDs, Physician Assistants, Service of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil.

Heitor Naoki Sado

Marcos Santos Lima

Physician Assistants, Service of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil.Instituto do Câncer do Estado de São Paulo Octavio Frias de OliveiraBrazilSão Paulo, SP, BrazilPhysician Assistants, Service of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil.

Giovanna Carvalho

Marcelo Tatit Sapienza

Private Docent, Professor, Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.Universidade de São PauloBrazilSão Paulo, SP, BrazilPrivate Docent, Professor, Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.

Carlos Alberto Buchpiguel

Private Docent, Full Professor, Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.Universidade de São PauloBrazilSão Paulo, SP, BrazilPrivate Docent, Full Professor, Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.

Mailing Address: Dra. Monique Beraldo Ordones. Instituto do Câncer do Estado de São Paulo – Setor de Medicina Nuclear. Avenida Doutor Arnaldo, 251, Sumaré. São Paulo, SP, Brazil, 01255-000. E-mail: moniqueordones@yahoo.com.br.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (4)

Thumbnail

Figure 1
¹⁸F-NaF PET image (A) shows osteogenic reaction in the region of the major trochanter and intertrochanteric sulcus of the right femur, suggesting secondary involvement by the underlying disease. Coronal (B) and axial (C) pelvic CT performed after 15 months revealing possible heterotopic calcification in this region, classified as a probably benign lesion.

Thumbnail

Figure 2
Coronal fusion PET/CT (A) and PET (B) with ¹⁸F-NaF show osteogenic reaction at right femoral head and neck, suspicious for bone involvement secondary to the underlying disease. Pelvic MRI coronal section T1-weighted image with fat suppression after intravenous gadolinium injection (C) shows expansile lesion infiltrating the bone marrow of the right femoral head and neck, suggestive of secondary finding. Also a medullary lesion is observed in the femoral diaphysis suspicious for secondary involvement.

Thumbnail

Figure 3
MRI coronal section of left hip – T1-weighted image with fat suppression after intravenous gadolinium injection (A) shows nodular lesion measuring 1.7 cm in the intertrochanteric region. ¹⁸F-NaF PET – coronal section (B) shows focal hyper-uptake in the same region, suspicious for secondary involvement; coronal ¹⁸F-NaF PET and MRI fusion of left hip (C) reveals correspondence of metabolic and anatomic findings.

Thumbnail

Figure 4
Coronal CT (A), PET (B) and ¹⁸F-NaF PET/CT fusion (C) images show osteogenic reaction in the distal metaphyseal region of the left femur, suggestive of metastatic bone infiltration originating from melanoma. Osteogenic reaction of probable osteodegenerative origin is also observed.

Figure 1 ¹⁸F-NaF PET image (A) shows osteogenic reaction in the region of the major trochanter and intertrochanteric sulcus of the right femur, suggesting secondary involvement by the underlying disease. Coronal (B) and axial (C) pelvic CT performed after 15 months revealing possible heterotopic calcification in this region, classified as a probably benign lesion.

Figure 2 Coronal fusion PET/CT (A) and PET (B) with ¹⁸F-NaF show osteogenic reaction at right femoral head and neck, suspicious for bone involvement secondary to the underlying disease. Pelvic MRI coronal section T1-weighted image with fat suppression after intravenous gadolinium injection (C) shows expansile lesion infiltrating the bone marrow of the right femoral head and neck, suggestive of secondary finding. Also a medullary lesion is observed in the femoral diaphysis suspicious for secondary involvement.

Figure 3 MRI coronal section of left hip – T1-weighted image with fat suppression after intravenous gadolinium injection (A) shows nodular lesion measuring 1.7 cm in the intertrochanteric region. ¹⁸F-NaF PET – coronal section (B) shows focal hyper-uptake in the same region, suspicious for secondary involvement; coronal ¹⁸F-NaF PET and MRI fusion of left hip (C) reveals correspondence of metabolic and anatomic findings.

Figure 4 Coronal CT (A), PET (B) and ¹⁸F-NaF PET/CT fusion (C) images show osteogenic reaction in the distal metaphyseal region of the left femur, suggestive of metastatic bone infiltration originating from melanoma. Osteogenic reaction of probable osteodegenerative origin is also observed.

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Prevalence of exclusive lower extremity metastases at <sup>18</sup>F-NaF PET/CT

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[1] Mailing Address: Dra. Monique Beraldo Ordones. Instituto do Câncer do Estado de São Paulo – Setor de Medicina Nuclear. Avenida Doutor Arnaldo, 251, Sumaré. São Paulo, SP, Brazil, 01255-000. E-mail: moniqueordones@yahoo.com.br.