Benign Bone Conditions That May Be FDG-avid and Mimic Malignancy

Area of Science:

• Nuclear Medicine
• Radiology
• Oncology

Background:

• ¹⁸F-fluoro-2-deoxy-d-glucose (FDG) Positron Emission Tomography (PET) is vital for assessing bone pathology.
• FDG is not specific to cancer, leading to potential misinterpretation of benign bone conditions as malignant.

Purpose of the Study:

• To review and illustrate benign bone conditions that exhibit high FDG uptake, mimicking malignancy.
• To aid clinicians in differentiating benign from malignant FDG-avid bone lesions, optimizing patient management.

Main Methods:

• Comprehensive literature review of benign bone pathologies with FDG avidity.
• Categorization of benign conditions including infections, systemic diseases, primary bone lesions, and miscellaneous findings.
• Illustration of imaging characteristics to differentiate benign from malignant lesions.

Main Results:

• FDG avidity is observed in various benign bone conditions such as osteomyelitis, brown tumors, Langerhans cell histiocytosis, bone cysts, fractures, and Paget disease.
• Ancillary clinical and imaging findings can assist in distinguishing benign from malignant FDG-avid bone lesions.
• Distinguishing benign from malignant lesions can be challenging, sometimes necessitating tissue biopsy for definitive diagnosis.

Conclusions:

• A wide spectrum of benign bone conditions can present as FDG-avid lesions on PET scans.
• Awareness of these mimics is essential for accurate interpretation and appropriate patient management, potentially avoiding invasive procedures.
• While imaging aids differentiation, definitive diagnosis may require histopathological confirmation.