Evaluation of subcentimeter pulmonary nodules is a known limitation of FDG-PET/CT because of the inherent resolution constraints of PET/CT technology and respiratory motion artifact. However, a study of 63 lung nodules in 18 pediatric patients with bone sarcoma did demonstrate the benefit of using an FDG-PET SUV cutoff in evaluating small pulmonary nodules; using an SUVmax >1 cutoff value and a nodule diameter cutoff of 6 mm can differentiate benign and malignant nodules with an accuracy of 92.1% compared with an accuracy of 88.9% with FDG-PET/CT visual analysis alone [16]. 8 Malignant or Aggressive Primary Musculoskeletal Tumor FDG-PET/MRI Whole Body There is no relevant literature to support the use of FDG-PET/MRI in the evaluation of pulmonary metastases during surveillance of malignant or aggressive primary musculoskeletal tumors. The inherent decreased spatial resolution of MRI compared with CT raises doubts about the ability to identify small pulmonary metastases with FDG- PET/MRI as accurately as CT. MRI of the lungs relies heavily on the ability to minimize respiratory motion. Radiography Chest Chest radiography is less sensitive than CT chest imaging for the detection of pulmonary nodules. Whooley et al [57] found that 83% of asymptomatic metastases were detected radiographically with a positive predictive value of 92% and a negative predictive value of 97%. However, the detection of more and smaller pulmonary metastases with CT versus radiography has definitely not improved survival rates. Although radiography is less sensitive for detection of lung metastases, how that correlates with clinically significant metastases is less certain. Variant 4: Malignant or aggressive primary bone tumor. Surveillance for local recurrence. The body regions covered in this clinical scenario are ankle, chest, elbow, shoulder, femur, foot, forearm, hand, humerus, knee, pelvis, tibia/fibula, and wrist.
Malignant or Aggressive Primary Musculoskeletal Tumor Staging And Surveillance PCAs. Evaluation of subcentimeter pulmonary nodules is a known limitation of FDG-PET/CT because of the inherent resolution constraints of PET/CT technology and respiratory motion artifact. However, a study of 63 lung nodules in 18 pediatric patients with bone sarcoma did demonstrate the benefit of using an FDG-PET SUV cutoff in evaluating small pulmonary nodules; using an SUVmax >1 cutoff value and a nodule diameter cutoff of 6 mm can differentiate benign and malignant nodules with an accuracy of 92.1% compared with an accuracy of 88.9% with FDG-PET/CT visual analysis alone [16]. 8 Malignant or Aggressive Primary Musculoskeletal Tumor FDG-PET/MRI Whole Body There is no relevant literature to support the use of FDG-PET/MRI in the evaluation of pulmonary metastases during surveillance of malignant or aggressive primary musculoskeletal tumors. The inherent decreased spatial resolution of MRI compared with CT raises doubts about the ability to identify small pulmonary metastases with FDG- PET/MRI as accurately as CT. MRI of the lungs relies heavily on the ability to minimize respiratory motion. Radiography Chest Chest radiography is less sensitive than CT chest imaging for the detection of pulmonary nodules. Whooley et al [57] found that 83% of asymptomatic metastases were detected radiographically with a positive predictive value of 92% and a negative predictive value of 97%. However, the detection of more and smaller pulmonary metastases with CT versus radiography has definitely not improved survival rates. Although radiography is less sensitive for detection of lung metastases, how that correlates with clinically significant metastases is less certain. Variant 4: Malignant or aggressive primary bone tumor. Surveillance for local recurrence. The body regions covered in this clinical scenario are ankle, chest, elbow, shoulder, femur, foot, forearm, hand, humerus, knee, pelvis, tibia/fibula, and wrist.