Increased bone uptake at the primary resection site is nonspecific and can occur for many reasons, including stress changes from adjacent hardware, fractures, and possibly recurrence. With advances in MRI, CT, and PET imaging, the use of bone scan for local recurrence surveillance has decreased. Studies have shown superiority of FDG-PET/CT and MRI versus bone scan for assessment of bone metastases (see Variant 2). Although historically, Tc-99m bone scan has been used to detect bone metastasis, more recent studies have shown Tc-99m bone scan is inferior to FDG-PET/CT in the detection of bone metastases in general oncologic populations [23]. A smaller study of 64 pediatric patients with bone sarcoma also showed greater accuracy of FDG-PET/CT (84%) versus Tc-99m bone scan (70%) in detecting bone metastases during initial staging [22]. There is no relevant literature to support the use of bone scan whole body for surveillance of local recurrence of malignant or aggressive primary bone tumors. Bone Scan Whole Body with SPECT or SPECT/CT Area of Interest There is no relevant literature to support the use of bone scan whole body with SPECT or SPECT/CT area of interest for surveillance of local recurrence of malignant or aggressive primary bone tumors. CT Area of Interest With IV Contrast CT can be useful for surveillance of local recurrence when MRI is unable to be obtained. CT imaging can also be of benefit if metal artifact on MRI cannot be resolved, although it should be noted, CT is also susceptible to artifact from metal hardware. Although IV contrast does not provide added benefit for evaluation of bone, given many bone sarcoma recurrences present as soft tissue masses, IV contrast can be useful to increase the conspicuity of enhancing soft tissue tumors. 9 Malignant or Aggressive Primary Musculoskeletal Tumor
Malignant or Aggressive Primary Musculoskeletal Tumor Staging And Surveillance PCAs. Increased bone uptake at the primary resection site is nonspecific and can occur for many reasons, including stress changes from adjacent hardware, fractures, and possibly recurrence. With advances in MRI, CT, and PET imaging, the use of bone scan for local recurrence surveillance has decreased. Studies have shown superiority of FDG-PET/CT and MRI versus bone scan for assessment of bone metastases (see Variant 2). Although historically, Tc-99m bone scan has been used to detect bone metastasis, more recent studies have shown Tc-99m bone scan is inferior to FDG-PET/CT in the detection of bone metastases in general oncologic populations [23]. A smaller study of 64 pediatric patients with bone sarcoma also showed greater accuracy of FDG-PET/CT (84%) versus Tc-99m bone scan (70%) in detecting bone metastases during initial staging [22]. There is no relevant literature to support the use of bone scan whole body for surveillance of local recurrence of malignant or aggressive primary bone tumors. Bone Scan Whole Body with SPECT or SPECT/CT Area of Interest There is no relevant literature to support the use of bone scan whole body with SPECT or SPECT/CT area of interest for surveillance of local recurrence of malignant or aggressive primary bone tumors. CT Area of Interest With IV Contrast CT can be useful for surveillance of local recurrence when MRI is unable to be obtained. CT imaging can also be of benefit if metal artifact on MRI cannot be resolved, although it should be noted, CT is also susceptible to artifact from metal hardware. Although IV contrast does not provide added benefit for evaluation of bone, given many bone sarcoma recurrences present as soft tissue masses, IV contrast can be useful to increase the conspicuity of enhancing soft tissue tumors. 9 Malignant or Aggressive Primary Musculoskeletal Tumor