There is no relevant literature to support the use of localized CT at an area of interest in the initial staging for extrapulmonary metastasis of malignant or aggressive musculoskeletal tumors; rather, a systemic approach to initial staging is recommended. CT Area of Interest Without IV Contrast CT can be used to evaluate an area of interest identified clinically or from another imaging modality. There is no relevant literature to support the use of localized CT at an area of interest in the initial staging for extrapulmonary metastasis of malignant or aggressive musculoskeletal tumors; rather, a systemic approach to initial staging is recommended. FDG-PET/CT Whole Body A meta-analysis of FDG-PET/CT for the staging of patients with osteosarcoma demonstrated an overall sensitivity of 93% and a specificity of 97% for detection of bone metastases [6]. Coverage of a whole body FDG-PET/CT varies and usually extends either from skull base to thighs or skull vertex to feet. A study of FDG-PET/CT in patients with sarcoma and melanoma showed inclusion of the entire lower extremities does not add additional benefit in identifying metastases [31]. FDG-PET/CT is considered superior to Tc-99m bone scan in the detection of osseous metastases. Literature has concluded this in both general oncologic and bone sarcoma populations [30]. FDG-PET/CT is also superior to CT imaging in this regard. Quartuccio et al [22] studied 64 pediatric patients with bone sarcoma and found greater accuracy of FDG-PET/CT (85% accuracy) versus CT (44% accuracy) in detecting bone metastases during initial staging of patients with Ewing sarcoma. There are mixed conclusions when comparing FDG-PET/CT versus MRI whole body in detecting osseous metastases in general oncology populations [32-34]. In a small study of 20 patients with Ewing sarcoma comparing FDG-PET/CT with MRI whole body, a single patient had a false-positive bone finding on FDG-PET/CT.
Malignant or Aggressive Primary Musculoskeletal Tumor Staging And Surveillance PCAs. There is no relevant literature to support the use of localized CT at an area of interest in the initial staging for extrapulmonary metastasis of malignant or aggressive musculoskeletal tumors; rather, a systemic approach to initial staging is recommended. CT Area of Interest Without IV Contrast CT can be used to evaluate an area of interest identified clinically or from another imaging modality. There is no relevant literature to support the use of localized CT at an area of interest in the initial staging for extrapulmonary metastasis of malignant or aggressive musculoskeletal tumors; rather, a systemic approach to initial staging is recommended. FDG-PET/CT Whole Body A meta-analysis of FDG-PET/CT for the staging of patients with osteosarcoma demonstrated an overall sensitivity of 93% and a specificity of 97% for detection of bone metastases [6]. Coverage of a whole body FDG-PET/CT varies and usually extends either from skull base to thighs or skull vertex to feet. A study of FDG-PET/CT in patients with sarcoma and melanoma showed inclusion of the entire lower extremities does not add additional benefit in identifying metastases [31]. FDG-PET/CT is considered superior to Tc-99m bone scan in the detection of osseous metastases. Literature has concluded this in both general oncologic and bone sarcoma populations [30]. FDG-PET/CT is also superior to CT imaging in this regard. Quartuccio et al [22] studied 64 pediatric patients with bone sarcoma and found greater accuracy of FDG-PET/CT (85% accuracy) versus CT (44% accuracy) in detecting bone metastases during initial staging of patients with Ewing sarcoma. There are mixed conclusions when comparing FDG-PET/CT versus MRI whole body in detecting osseous metastases in general oncology populations [32-34]. In a small study of 20 patients with Ewing sarcoma comparing FDG-PET/CT with MRI whole body, a single patient had a false-positive bone finding on FDG-PET/CT.