There is no relevant literature specifically regarding the use of CT without and with IV contrast in the evaluation of suspected primary bone tumor with negative or equivocal radiographs or radiographs that do not explain symptoms. However, if contrast is given, CT without and with IV contrast is preferred because it allows differentiation of areas of contrast enhancement from areas of osseous matrix production. CT perfusion is a dynamic without and with IV contrast CT examination, which facilitates further characterization in the setting of suspected osteoid osteoma. A comparative study looking at CT perfusion parameters of 15 patients with a final diagnosis of osteoid osteoma, 15 patients with lesions that mimic osteoid osteomas, and 26 patients with other bone lytic lesions showed that enhancement curve morphology of the osteoid osteomas was significantly different from its mimickers. All osteoid osteomas had early enhancement with a delay between nidus and arterial peak below 30 seconds. Eighty percent of the mimickers demonstrated a slow and progressive pattern of enhancement. The perfusion parameters of the other lytic bone lesions were similar to those of the osteoid osteomas in 46.1% of the patients, indicating that early enhancement is suggestive but not pathognomonic of osteoid osteomas [16]. FDG-PET/CT Whole Body FDG-PET/CT is not routinely used in the evaluation of suspected osteoid osteoma. There is no relevant literature regarding the use of FDG-PET/CT in the evaluation of suspected osteoid osteoma. MRI Area of Interest MRI is generally considered inferior to CT in the evaluation of suspected osteoid osteoma because it may fail to demonstrate the typical nidus and can present a confounding imaging appearance. Davies et al [17] performed a retrospective review of the MRI findings of 43 patients with osteoid osteoma and then compared the results with those of other imaging modalities. The authors found that the potential for a missed diagnosis of osteoid osteoma on MRI was 35%.
Primary Bone Tumors. There is no relevant literature specifically regarding the use of CT without and with IV contrast in the evaluation of suspected primary bone tumor with negative or equivocal radiographs or radiographs that do not explain symptoms. However, if contrast is given, CT without and with IV contrast is preferred because it allows differentiation of areas of contrast enhancement from areas of osseous matrix production. CT perfusion is a dynamic without and with IV contrast CT examination, which facilitates further characterization in the setting of suspected osteoid osteoma. A comparative study looking at CT perfusion parameters of 15 patients with a final diagnosis of osteoid osteoma, 15 patients with lesions that mimic osteoid osteomas, and 26 patients with other bone lytic lesions showed that enhancement curve morphology of the osteoid osteomas was significantly different from its mimickers. All osteoid osteomas had early enhancement with a delay between nidus and arterial peak below 30 seconds. Eighty percent of the mimickers demonstrated a slow and progressive pattern of enhancement. The perfusion parameters of the other lytic bone lesions were similar to those of the osteoid osteomas in 46.1% of the patients, indicating that early enhancement is suggestive but not pathognomonic of osteoid osteomas [16]. FDG-PET/CT Whole Body FDG-PET/CT is not routinely used in the evaluation of suspected osteoid osteoma. There is no relevant literature regarding the use of FDG-PET/CT in the evaluation of suspected osteoid osteoma. MRI Area of Interest MRI is generally considered inferior to CT in the evaluation of suspected osteoid osteoma because it may fail to demonstrate the typical nidus and can present a confounding imaging appearance. Davies et al [17] performed a retrospective review of the MRI findings of 43 patients with osteoid osteoma and then compared the results with those of other imaging modalities. The authors found that the potential for a missed diagnosis of osteoid osteoma on MRI was 35%.