Other studies have suggested that this FDG- PET/CT superiority may be specific only to osteolytic metastases but not osteoblastic metastases [25-27]. The ability to detect extraosseous metastases that are usually occult on Tc-99m bone scan is an additional benefit of FDG-PET/CT [28]. Similarly, studies have demonstrated MRI whole body is superior to Tc-99m bone scan in detecting bone metastases in general populations. A study specific to patients with Ewing sarcoma of bone that had both MRI whole body and Tc-99m bone scan showed not only more bone metastases were identified with MRI, but 4 of the 71 patients had bone metastases only detected on MRI which changed the tumor stage for these patients [29]. Bone Scan Whole Body with SPECT or SPECT/CT Area of Interest The addition of single-photon emission computed tomography (SPECT) and SPECT/CT to Tc-99m bone scans can increase diagnostic confidence. A study of 2,954 Tc-99m bone scans in a general oncologic population increased diagnostic confidence by 75% and reduced equivocal findings by 27% [30]. However, there is no relevant literature 5 Malignant or Aggressive Primary Musculoskeletal Tumor to support the specific use of SPECT or SPECT/CT with bone scans in the initial staging for extrapulmonary metastasis of malignant or aggressive musculoskeletal tumors. CT Area of Interest With 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. CT Area of Interest Without and With IV Contrast CT can be used to evaluate an area of interest identified clinically or from another imaging modality.
Malignant or Aggressive Primary Musculoskeletal Tumor Staging And Surveillance PCAs. Other studies have suggested that this FDG- PET/CT superiority may be specific only to osteolytic metastases but not osteoblastic metastases [25-27]. The ability to detect extraosseous metastases that are usually occult on Tc-99m bone scan is an additional benefit of FDG-PET/CT [28]. Similarly, studies have demonstrated MRI whole body is superior to Tc-99m bone scan in detecting bone metastases in general populations. A study specific to patients with Ewing sarcoma of bone that had both MRI whole body and Tc-99m bone scan showed not only more bone metastases were identified with MRI, but 4 of the 71 patients had bone metastases only detected on MRI which changed the tumor stage for these patients [29]. Bone Scan Whole Body with SPECT or SPECT/CT Area of Interest The addition of single-photon emission computed tomography (SPECT) and SPECT/CT to Tc-99m bone scans can increase diagnostic confidence. A study of 2,954 Tc-99m bone scans in a general oncologic population increased diagnostic confidence by 75% and reduced equivocal findings by 27% [30]. However, there is no relevant literature 5 Malignant or Aggressive Primary Musculoskeletal Tumor to support the specific use of SPECT or SPECT/CT with bone scans in the initial staging for extrapulmonary metastasis of malignant or aggressive musculoskeletal tumors. CT Area of Interest With 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. CT Area of Interest Without and With IV Contrast CT can be used to evaluate an area of interest identified clinically or from another imaging modality.