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Updated: Jun 17, 2025

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Augmenting CT-Guided Bone Biopsies Using 18F-FDG PET/CT Guidance.

Max F Droste1, Floris H P van Velden1, Matthias N van Oosterom2

  • 1Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.

Cancers
|August 10, 2024
PubMed
Summary

Adding 2-deoxy-2-18F-fluoro-D-glucose-positron emission tomography (18F-FDG-PET)/CT scans significantly improves bone biopsy accuracy. This molecular imaging guidance reduces inconclusive results and misdiagnoses in patients with bone lesions.

Keywords:
18F-FDG PET/CTCT-guided biopsybone lesionshistopathologyimage-guided bone biopsy

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Area of Science:

  • Oncology
  • Radiology
  • Nuclear Medicine

Background:

  • Computer tomography (CT)-guided percutaneous core biopsies are standard for diagnosing bone lesions.
  • Challenges exist with CT-guided biopsies for small, heterogeneous, or radiographically subtle bone lesions, potentially leading to misdiagnosis or repeat procedures.

Purpose of the Study:

  • To evaluate if 2-deoxy-2-18F-fluoro-D-glucose-positron emission tomography (18F-FDG-PET)/CT imaging can enhance routine CT-guided bone biopsies.
  • To determine if molecular image guidance optimizes biopsy strategies by improving the detection of heterogeneous or radiographically indistinct lesions.

Main Methods:

  • A prospective study included 106 patients undergoing CT-guided bone biopsies (vertebral or peripheral).
  • Patients were divided into two groups: 36 received 18F-FDG-PET/CT prior to biopsy (PET group), and 70 had only a standard CT scan (CT group).
  • Biopsy results were categorized by histopathology.

Main Results:

  • The PET group showed a significantly higher rate of conclusive biopsies (92%) compared to the CT group (76%; p < 0.05).
  • The average number of first-try biopsies was lower in the PET group (1.9) versus the CT group (2.54; p = 0.051).

Conclusions:

  • 18F-FDG-PET/CT imaging significantly increases the diagnostic success rate of first-try CT-guided bone biopsies.
  • The addition of 18F-FDG-PET/CT reduces inconclusive biopsies and misdiagnoses, optimizing the diagnostic pathway for bone lesions.