This case study highlights the utility of FDG PET-CT in simultaneous diagnosis as well as pretreatment whole body staging of osteosarcoma in a patient presenting with rapidly progressive hard knee swelling.
24 years old Male patient was referred by an orthopedician for evaluation of rapidly increasing bony hard swelling over the left knee joint for 18F FDG PET/CT scan.
PET CT scan was done following intravenous administration of 18F FDG on a PET scanner with Multidetector Computerized Tomography (MDCT), scanning was performed from Head to Feet. A separate CT sequence with breath hold was performed for lung and a dedicated thin slice series for brain examination.
18F FDG PET/CT Scan MIP images revealed a large irregular intensely tracer avid mass along distal left femur (Fig 1. Black Arrow) and another discrete non-contiguous lesion along the mid shaft (Fig 2. Black Arrowhead). Rest of the body does not demonstrate any other obvious FDG avid abnormality.
CT and fused PET-CT images further demonstrate a hypermetabolic meta-diaphyseal lytic destructive mass lesion suspicious for primary mitotic etiology arising from distal left femur with associated significant infiltrating soft tissue component on corresponding axial soft tissue window (Fig 2a&b. white arrows), coronal soft tissue window (Fig 2c&d. white arrows) and coronal bone window (Fig 2e&f. white arrows) consistent with primary malignant bone etiology likely osteosarcoma.
Additionally, CT and fused PET-CT images also demonstrates another discrete non-contiguous hypermetabolic foci consistent with skip marrow lesion/metastases along mid femur as demonstrated in axial soft tissue window (Fig 3a&b. white arrows), axial bone window (Fig 3c&d. white arrows) and coronal soft tissue window (Fig 3e&f. white arrows).
A diagnosis of Osteosarcoma with skip lesion was then further confirmed using CT guided biopsy and MRI.
Additionally, FDG PET-CT was instrumental in effectively ruling out lung metastases providing valuable insights into disease management course, prognosis and expected long term outcomes.
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