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Evaluation of Bone Metastasis from Hepatocellular Carcinoma Using 18F-FDG PET/CTand 99mTc-HDP Bone Scintigraphy: Characteristics of Soft Tissue Formation.

 Hyo Jung Seo  ;  Yun Jung Choi  ;  Hyun Jeong Kim  ;  Yong Hyu Jeong  ;  Arthur Cho  ;  Jae Hoon Lee  ;  Mijin Yun  ;  Hye Jin Choi  ;  Jong Doo Lee  ;  Won Jun Kang 
 Nuclear Medicine and Molecular Imaging, Vol.45(3) : 203-211, 2011 
Journal Title
 Nuclear Medicine and Molecular Imaging (핵의학 분자영상) 
Issue Date
Hepatocellular carcinoma ; Fluorodeoxyglucose ; Positron emission tomography ; Soft tissue formation ; Bone metastasis
PURPOSE: Bone metastasis from hepatocellular carcinoma (HCC) can present with soft tissue formation, resulting in oncologic emergency. Contrast-enhanced FDG PET/CT and bone scintigraphy were compared to evaluate characteristics of bone metastases with or without soft tissue formation from HCC. METHODS: Of 4,151 patients with HCC, 263 patients had bone metastases. Eighty-five patients with bone metastasis from HCC underwent contrast-enhanced FDG PET/CT. Fifty-four of the enrolled subjects had recent 99mTc-HDP bone scintigraphy available for comparison. Metastatic bone lesions were identified with visual inspection on FDG PET/CT, and maximum standardized uptake value (SUVmax) was used for the quantitative analysis. Confirmation of bone metastasis was based on histopathology, combined imaging modalities, or serial follow-up studies. RESULTS: Forty-seven patients (55%) presented with soft tissue formation, while the remaining 38 patients presented without soft tissue formation. Frequent sites of bone metastases from HCC were the spine (39%), pelvis (19%), and rib cage (14%). The soft-tissue-formation group had more frequent bone pain (77 vs. 37%, p<0.0001), higher SUVmax (6.02 vs. 3.52, p<0.007), and higher incidence of photon defect in bone scintigraphy (75 vs. 0%) compared to the non-soft-tissue-formation group. FDG PET/CT had higher detection rate for bone metastasis than bone scintigraphy both in lesion-based analysis (98 vs. 53%, p=0.0015) and in patient-based analysis (100 vs. 80%, p<0.001). CONCLUSIONS: Bone metastasis from HCC showed a high incidence of soft tissue formation requiring emergency treatment. Although the characteristic findings for soft tissue formation such as photon defect in bone scintigraphy are helpful in detection, overall detectability of bone metastasis is higher in FDG PET/CT. Contrast-enhanced PET/CT will be useful in finding and delineating soft-tissue-forming bone metastasis from HCC
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Won Jun(강원준) ORCID logo https://orcid.org/0000-0002-2107-8160
Yun, Mi Jin(윤미진) ORCID logo https://orcid.org/0000-0002-1712-163X
Lee, Jae Hoon(이재훈) ORCID logo https://orcid.org/0000-0002-9898-9886
Lee, Jong Doo(이종두)
Jeong, Yong Hyu(정용휴) ORCID logo https://orcid.org/0000-0002-0198-0026
Cho, Arthur Eung Hyuck(조응혁) ORCID logo https://orcid.org/0000-0001-8670-2473
Choi, Hye Jin(최혜진) ORCID logo https://orcid.org/0000-0001-5917-1400
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