Malignant Involvement of the Spine: Assessment by 18F-FDG PET/CT

The purpose of the study was to assess the role of (18)F-FDG PET/CT in the assessment of secondary malignant involvement of the spinal column. In 51 patients, 242 lesions at the spinal region detected on (18)F-FDG PET/CT were interpreted separately on PET, CT, and fused PET/CT images, including differentiation between benign and malignant lesions and the level in the vertebral column. CT evaluation also included the type of bony lesion (osteolytic, osteoblastic, or mixed) and accompanying soft-tissue abnormalities; for example, epidural masses and tumor involvement of the neural foramina. Of the 242 lesions detected on PET/CT, PET alone identified 220 lesions and CT alone identified 159; 217 (90%) were malignant and 25 benign. (18)F-FDG PET alone detected significantly more malignant lesions than did CT alone (96% vs. 68%, respectively, P < 0.001). The specificity was 56% for both PET alone and CT alone. PET alone was incorrect in determining the level of abnormality within the vertebral column in 33 (15%) lesions and in determining the part of the vertebra involved in 40 (18%) lesions. In 17 (33%) patients, either epidural extension of tumor (n = 7 lesions), neural foramen involvement of tumor (n = 7 lesions), or a combination of both (n = 11 lesions) was detected. On a patient-based analysis, the sensitivity of PET and of PET/CT for the detection of spinal metastasis was 98% and 74%, respectively (P < 0.01). (18)F-FDG PET/CT has better specificity for detection of malignant involvement of the spine than does (18)F-FDG PET. It allows for precise localization of lesions and identifies accompanying soft-tissue involvement, which is of potential neurologic significance.