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Liu X, Yan S, Qin X, Cheng K, Zheng J, Wu H, Wei Y, Yuan S. Increased 18F-FAPI uptake in bones and joints of lung cancer patients: characteristics and distributions. Skeletal Radiol 2023; 52:2377-2386. [PMID: 37129613 DOI: 10.1007/s00256-023-04335-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE This study investigated the distribution and characteristics of various bone and joint lesions on 18F-FAPI PET/CT in lung cancer patients. METHODS Seventy-four lung cancer patients who underwent 18F-FAPI PET/CT were reviewed. Bone and joint lesions with elevated 18F-FAPI uptake were recorded and analyzed. The distribution and maximum uptake value (SUVmax) of different benign lesions or bone metastases were presented. In addition, the SUVmax of bone metastases on 18F-FDG and 18F-FAPI-04 PET/CT were also compared. RESULTS In 53 patients, a total of 262 lesions presented 18F-FAPI accumulation. Bone metastases were mainly in vertebrae, pelvis, and ribs, while benign lesions were in vertebral margins, alveolar bone, and shoulder joints. The SUVmax of bone metastases was significantly higher than that of benign lesions ([Formula: see text] vs. [Formula: see text], [Formula: see text]), with NSCLC cases having higher SUVmax values than SCLC cases ([Formula: see text] vs. [Formula: see text], [Formula: see text]). Among benign lesions, arthritis and periodontitis demonstrated higher SUVmax than degenerative lesions (arthritis: [Formula: see text]; periodontitis: [Formula: see text]; degenerative diseases: [Formula: see text]; [Formula: see text] and [Formula: see text], respectively). The SUVmax of bone metastases was comparable between 18F-FDG and 18F-FAPI PET/CT. However, 18F-FAPI PET/CT was found to be superior in identifying cranial metastases compared to 18F-FDG PET/CT (TBRmet/brain: [Formula: see text] vs. [Formula: see text], [Formula: see text]). CONCLUSION This study demonstrated that 18F-FAPI PET/CT is a valuable imaging modality for detecting bone and joint lesions in lung cancer patients. The SUVmax of malignant lesions was higher than that of benign lesions, but cannot accurately distinguish benign and malignant lesions. The uptake of FAPI differs among lesions with different pathological types.
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Affiliation(s)
- Xiaoli Liu
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Department of Radiotherapy, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shoumei Yan
- Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xueting Qin
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Kai Cheng
- Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jinsong Zheng
- Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Hongbo Wu
- Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yuchun Wei
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
| | - Shuanghu Yuan
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
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Oh E, Kim HJ, Kwon JW, Yoon YC, Kim HS. Differentiation between spinal subchondral bone metastasis with focal pathologic endplate fracture and oedematous Schmorl's node. J Med Imaging Radiat Oncol 2021; 66:913-919. [PMID: 34854219 DOI: 10.1111/1754-9485.13365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/18/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We aimed to identify imaging-based findings that can differentiate between spinal subchondral bone metastasis with focal pathologic endplate fracture and oedematous Schmorl's nodes that have been histopathologically confirmed. METHODS Between March 2010 and April 2016, 11 patients who had undergone spinal magnetic resonance (MR) imaging or computed tomography (CT) with final radiologic reports that included 'subchondral bone metastasis with focal pathologic endplate fracture' or 'edematous Schmorl's node' and had also undergone percutaneous imaging-guided spinal biopsies were included. Two radiologists retrospectively evaluated the following imaging features in consensus: size, location, presence of sclerotic margin, presence of intralesional or perilesional enhancement and opposite endplate enhancement of the involved disc, presence of disc height loss and presence of metabolic uptake at a corresponding lesion on nuclear medicine imaging. RESULTS A total of 11 patients, including six patients with spinal subchondral bone metastasis with focal pathologic endplate fracture and five patients with oedematous Schmorl's nodes, were included in this study (median age, 58 years; range, 50-63 years; six men). Sclerotic margin (P = 0.002) and enhancement on the opposite endplate of the involved disc (P = 0.047) were significantly different between oedematous Schmorl's node and subchondral bone metastasis with focal pathologic endplate fracture. CONCLUSION Sclerotic margin and enhancement on the opposite endplate of the involved disc suggest oedematous Schmorl's node rather than subchondral bone metastasis with focal pathologic endplate fracture. Decreased disc height is likely to be an oedematous Schmorl's node rather than subchondral bone metastasis with focal pathologic endplate fracture.
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Affiliation(s)
- Eunsun Oh
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hyun-Joo Kim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jong Won Kwon
- Department of Radiology, Dongcheondongkang Hospital, Ulsan, Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Su Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Diehn FE, Maus TP, Morris JM, Carr CM, Kotsenas AL, Luetmer PH, Lehman VT, Thielen KR, Nassr A, Wald JT. Uncommon Manifestations of Intervertebral Disk Pathologic Conditions. Radiographics 2016; 36:801-23. [PMID: 27082664 DOI: 10.1148/rg.2016150223] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Beyond the familiar disk herniations with typical clinical features, intervertebral disk pathologic conditions can have a wide spectrum of imaging and clinical manifestations. The goal of this review is to illustrate and discuss unusual manifestations of intervertebral disk pathologic conditions that radiologists may encounter, including disk herniations in unusual locations, those with atypical imaging features, and those with uncommon pathophysiologic findings. Examples of atypical disk herniations presented include dorsal epidural, intradural, symptomatic thoracic (including giant calcified), extreme lateral (retroperitoneal), fluorine 18 fluorodeoxyglucose-avid, acute intravertebral (Schmorl node), and massive lumbar disk herniations. Examples of atypical pathophysiologic conditions covered are discal cysts, fibrocartilaginous emboli to the spinal cord, tiny calcified disks or disk-level spiculated osteophytes causing spinal cerebrospinal fluid (CSF) leak and intracranial hypotension, and pediatric acute calcific discitis. This broad gamut of disease includes a variety of sizes of disk pathologic conditions, from the tiny (eg, the minuscule calcified disks causing high-flow CSF leaks) to the extremely large (eg, giant calcified thoracic intradural disk herniations causing myelopathy). A spectrum of clinical acuity is represented, from hyperacute fibrocartilaginous emboli causing spinal cord infarct, to acute Schmorl nodes, to chronic intradural herniations. The entities included are characterized by a range of clinical courses, from the typically devastating cord infarct caused by fibrocartilaginous emboli, to the usually spontaneously resolving pediatric acute calcific discitis. Several conditions have important differential diagnostic considerations, and others have relatively diagnostic imaging findings. The pathophysiologic findings are well understood for some of these entities and poorly defined for others. Radiologists' knowledge of this broad scope of unusual disk disease is critical for accurate radiologic diagnoses. Online supplemental material is available for this article. (©)RSNA, 2016.
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Affiliation(s)
- Felix E Diehn
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Timothy P Maus
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Jonathan M Morris
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Carrie M Carr
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Amy L Kotsenas
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Patrick H Luetmer
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Vance T Lehman
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Kent R Thielen
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Ahmad Nassr
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - John T Wald
- From the Departments of Radiology (F.E.D., T.P.M., J.M.M., C.M.C., A.L.K., P.H.L., V.T.L., K.R.T., J.T.W.) and Orthopedic Surgery (A.N.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Daignault CP, Palmer EL, Scott JA, Swan JS, Daniels GH. Papillary Thyroid Carcinoma Metastasis to the Lumbar Spine Masquerading as a Schmorl's Node. Nucl Med Mol Imaging 2015; 49:217-22. [PMID: 26279695 DOI: 10.1007/s13139-015-0320-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/15/2015] [Accepted: 01/18/2015] [Indexed: 11/26/2022] Open
Abstract
A Schmorl's node is a common incidental finding encountered during radiologic imaging. Despite the vertebral body being a common site of metastatic disease, a lytic lesion adjacent to an endplate with typical imaging features can often confidently be called a Schmorl's node. This is a case report of a patient with a single well-defined FDG-avid papillary thyroid carcinoma metastasis to the spine that had imaging findings characteristic of a Schmorl's node on CT and MRI. This case is important to consider as it demonstrates that the imaging characteristics of metastatic disease and Schmorl's nodes can overlap.
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Affiliation(s)
- Cory P Daignault
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA ; Department of Radiology, Division of Nuclear Medicine, UMass Memorial Medical Center, 55 Lake Ave N, Worcester, MA 01655 USA
| | - Edwin L Palmer
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - James A Scott
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - John S Swan
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - Gilbert H Daniels
- Thyroid Unit and Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
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