Abstract
We report the case of a 32 year-old male with Chondroblastic Osteosarcoma of the skull, which was imaged with both 18[F]fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and 68Gallium-arginine-glycine-aspartic acid (68Ga-RGD) PET/CT. The 18F-FDG PET/CT did not demonstrate the tumour, whereas the 68Ga-RGD PET/CT clearly depicted a left-sided frontal tumour. 68Ga-RGD PET/CT may be a clinically useful imaging modality for early detection of recurrent osteosarcoma, considering the limitations of 18F-FDG PET in a setting of low glycolytic activity.
Keywords: Chondroblastic Osteosarcoma, 18F-FDG, 68Ga-RGD, PET/CT
Fig. 1.
This 32 year old male underwent both 18F-FDG and 68Ga-RGD PET/CT for suspected recurrence following complaints of new-onset bone pain. He had completed chemotherapy and radiotherapy following surgical excision of the left frontal bone tumour which confirmed Chondroblastic Osteosarcoma. 18F-FDG images on the right demonstrate no uptake in the left sided skull lesion whereas 68Ga-RGD images are discordant with 18F-FDG findings. Noninvasive PET imaging of integrin αvβ3 with 68Gallium-arginine-glycine-aspartic acid (68Ga-RGD) has become an important tool for tumour diagnosis and treatment monitoring in both preclinical and clinical studies [1, 2]. Both, integrin αvβ3 expression and glucose metabolism were believed to correlate with tumour aggressiveness and progression despite their completely different pharmacodynamic mechanisms [3, 4]. Recently, other studies have demonstrated that 18[F]fluorodeoxyglucose (18F-FDG) uptake is independent of angiogenesis and that there is no correlation between 18F-FDG uptake and angiogenesis [5, 6]. No studies have been done with 68Ga-RGD for osteosarcoma or for Chondroblastic Osteosarcoma
Fig. 2.
Histology of the left frontal bone lesion demonstrated atypical chondroid areas with pleomorphic and atypical binucleate cells; large hyperchromatic nuclei are demonstrated. Although it has been established that 18F-FDG PET has a very high sensitivity in detecting primary osteosarcoma lesions [5, 7, 8], it is not considered a diagnostic tool to prove the presence of osteosarcoma. Since no correlation between 18F-FDG uptake and angiogenesis was found in this case, 68Ga-RGD could be considered as an alternative diagnostic tool in osteosarcomas with low 18F-FDG avidity
Acknowledgments
Ms. I Schoeman and Dr. B Mokaleng for their contributions to ensuring quality control of Ga68 radiopharmaceuticals. We thank Prof. E Raubenheimer who provided histology images on behalf of George Mukhari Academic Hospital.
Abbreviations
- PET/CT
Positron emission tomography/computed tomography
- 68Ga-RGD
68Gallium-arginine-glycine-aspartic acid
- 18F-FDG
18[F]fluorodeoxyglucose
Compliance with Ethical Standards
Conflict of Interest
Akintunde Orunmuyi, Moshe Modiselle, Thabo Lengana, Thomas Ebenhan, Mariza Vorster, and Mike Sathekge, declare that they have no conflict of interest.
Ethical Statement
This study was approved by the University of Pretoria’s Research Ethics committee and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
Contributor Information
Akintunde Orunmuyi, Email: akin2nde@gmail.com.
Moshe Modiselle, Email: modisellemoshe@yahoo.co.uk.
Thabo Lengana, Email: tlengana@gmail.com.
Thomas Ebenhan, Email: thomas.ebenhan@gmail.com.
Mariza Vorster, Email: marizavorster@gmail.com.
Mike Sathekge, Phone: +27 12 354 17, Email: mike.sathekge@up.ac.za.
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