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Open Access Highly Accessed Research article

Prevalence and patterns of soft tissue metastasis: detection with true whole-body F-18 FDG PET/CT

Nghi C Nguyen1*, Bassem T Chaar2 and Medhat M Osman1

Author Affiliations

1 Division of Nuclear Medicine, Department of Radiology, Saint Louis University Hospital, St. Louis, USA

2 Division of Hematology and Oncology, Department of Internal Medicine, Saint Louis University Hospital, St. Louis, USA

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BMC Medical Imaging 2007, 7:8  doi:10.1186/1471-2342-7-8

Published: 12 December 2007

Abstract

Background

The aim of this retrospective study was to report the prevalence and patterns of soft tissue (ST) metastasis detected with true whole-body (TWB) F-18 FDG PET/CT acquired from the top of the skull through the bottom of the feet and to compare such findings to that of the typically acquired skull-base to upper-thigh, thus limited whole-body (LWB) field of view (FOV).

Methods

TWB FDG-PET/CT scans were performed in 500 consecutive cancer patients. Suspected ST metastasis was verified by correlation with surgical pathology, other imaging modalities, or clinical follow-up.

Results

Nine out of 500 patients (1.8 %) had ST metastasis with a prevalence of 4/41 (9.8%) for melanoma, 2/60 (3.3%) for lung carcinoma, 2/88 (2.3%) for lymphoma and 1/13 (77%) for esophageal cancer. Those nine patients had a total of 41 ST lesions: 22 lesions within and 19 outside of LWB FOV. Of those 41 lesions, 19 (46%) were subcutaneous and 22 (54%) were muscular lesions. The presence of ST metastasis neither changed the staging nor the treatment in any of these patients. However, the ST lesions provided a biopsy site in 4 of the 9 patients (44%). Seven out of nine studied patients died of their disease within 1–22 months after ST metastasis was diagnosed.

Conclusion

The detection of ST metastasis may have prognostic implications, provide more accessible biopsy sites and help avoid invasive procedures. A LWB scanning may underestimate the true extent of ST metastasis since a significant percentage of ST metastasis (46%) occurred outside the typical LWB FOV.