From the Department of Radiology, Mayo Clinic, Rochester, MN.
Clin Nucl Med. 2016 Jan;41(1):e24-31. doi: 10.1097/RLU.0000000000000893.
This study evaluated the semiquantitative and qualitative appearance of pigmented villonodular synovitis (PVNS) and giant cell tumor of the tendon sheath (GCTTS) on 18F-FDG PET/CT.
An institutional review board-approved retrospective review was performed for patients diagnosed with GCTTS, focal PVNS, or diffuse PVNS who underwent PET/CT from 2003 to 2013. SUVmax and SUVmax/SUVmean of the liver (SUVr) were determined for each lesion on all available PET/CTs. Relevant conventional imaging and patient records were reviewed.
Fourteen patients (mean [SD] age, 52.8 [14.0] years; range, 26-74 years) were identified, 6 with 2 or more PET/CT examinations. The mean (SD) SUVmax and SUVr of all lesions were 8.7 (3.4; range, 4.0-14.5) and 3.9 (1.7; range, 2.0-7.1), respectively. There was no difference of the mean (SD) SUVmax (P = 0.10) or SUVr (P = 0.11) between focal PVNS (6.8 [3.0], 3.3 [1.9]), GCTTS (9.1 [3.0], 4.0 [1.2]), or diffuse PVNS (14.5, 7.1) subtypes. Of 29 comparison PET/CTs in 6 patients, 17 were performed after nontargeted chemotherapy and 12 without antecedent therapy. Significant SUVr fluctuations (>25%) occurred in 11 cases; no correlation existed between SUVr change and presence or absence of chemotherapy.
Pigmented villonodular synovitis and GCTTS can be intensely hypermetabolic, mimicking musculoskeletal metastases on 18F-FDG PET/CT. They may have significant SUV fluctuations, both during nontargeted chemotherapy and between treatments. The diagnosis of PVNS/GCTTS should be considered for focal intra-articular or juxta-articular FDG-avid lesions, and MRI is useful in further evaluation given the often diagnostic imaging features with this modality.
本研究评估了氟代脱氧葡萄糖（18F-FDG）PET/CT 对色素绒毛结节性滑膜炎（PVNS）和腱鞘巨细胞瘤（GCTTS）的半定量和定性表现。
对 2003 年至 2013 年间接受 PET/CT 检查的经病理证实的 GCTTS、局限性 PVNS 或弥漫性 PVNS 患者进行机构审查委员会批准的回顾性研究。对所有 PET/CT 上的每个病灶均测定最大标准摄取值（SUVmax）和肝脏 SUVmax/SUVmean（SUVr）。回顾分析了相关的常规影像学和患者记录。
共确定了 14 例患者（平均[标准差]年龄，52.8[14.0]岁；范围，26-74 岁），其中 6 例患者有 2 次或更多次 PET/CT 检查。所有病灶的平均（标准差）SUVmax 和 SUVr 分别为 8.7（3.4；范围，4.0-14.5）和 3.9（1.7；范围，2.0-7.1）。局限性 PVNS（6.8[3.0]，3.3[1.9]）、GCTTS（9.1[3.0]，4.0[1.2]）和弥漫性 PVNS （14.5，7.1）这三种亚型之间的平均（标准差）SUVmax（P=0.10）或 SUVr（P=0.11）差异均无统计学意义。在 6 例患者的 29 次对比 PET/CT 中，17 次在非靶向化疗后进行，12 次无化疗前检查。11 例患者 SUVr 出现显著波动（>25%）；SUVr 变化与是否存在化疗之间无相关性。
氟代脱氧葡萄糖（18F-FDG）PET/CT 上色素绒毛结节性滑膜炎和腱鞘巨细胞瘤可能代谢活跃，类似于骨肌系统转移瘤。在非靶向化疗期间和治疗之间，它们的 SUVr 可能会有明显波动。对于关节内或关节旁 FDG 摄取的局灶性病变，应考虑诊断为 PVNS/GCTTS，鉴于这种病变的影像学特征，MRI 对进一步评估很有用。
