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Pigmented villonodular synovitis (PVNS) and giant cell tumor of the tendon sheath (GCTTS) show intense uptake on 18F-FDG PET/CT, mimicking metastases. These conditions can exhibit significant fluctuations in SUV uptake, regardless of chemotherapy.

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Area of Science:

  • Oncology
  • Radiology
  • Nuclear Medicine

Background:

  • Pigmented villonodular synovitis (PVNS) and giant cell tumor of the tendon sheath (GCTTS) are neoplastic conditions affecting the synovium and tendon sheath.
  • Accurate diagnosis is crucial for appropriate management and to differentiate from other bone and soft tissue pathologies.

Purpose of the Study:

  • To evaluate the semiquantitative and qualitative imaging characteristics of PVNS and GCTTS using 18F-FDG PET/CT.
  • To assess the metabolic activity and potential for FDG avidity in these lesions.

Main Methods:

  • Retrospective review of patients diagnosed with GCTTS, focal PVNS, or diffuse PVNS who underwent 18F-FDG PET/CT.
  • Determination of SUVmax and SUVr (SUVmax/SUVmean of the liver) for each lesion.
  • Review of conventional imaging and patient records.

Main Results:

  • Fourteen patients were included, with mean SUVmax of 8.7 and mean SUVr of 3.9.
  • No significant difference in SUVmax or SUVr was observed between focal PVNS, GCTTS, or diffuse PVNS subtypes.
  • Significant SUVr fluctuations (>25%) occurred in 11 cases, independent of chemotherapy status.

Conclusions:

  • PVNS and GCTTS can be intensely hypermetabolic on 18F-FDG PET/CT, potentially mimicking musculoskeletal metastases.
  • Significant fluctuations in SUV uptake can occur, necessitating careful interpretation.
  • Consider PVNS/GCTTS in the differential diagnosis of FDG-avid intra-articular or juxta-articular lesions; MRI is valuable for further assessment.