Purpose of review: This work is focused on (i) reviewing different tools of 18F-FDG PET/CT image analysis considering the most recent literature and our experience and (ii) their correlation with clinical outcome in the setting of osteosarcoma. Recent findings: Although there is a clear role for PET/CT in the staging of osteosarcoma, considerable debate exists concerning the use of PET/CT for prognostication. The potential to use PET/CT to predict clinical outcomes and treatment responses is an attractive concept, particularly prior to obtaining final surgical pathology at resection. SUV is the mainstay semi-quantitative measurement utilized, and multiple variables have been investigated to try to identify the most reproducible and significant predictor of prognosis, including SUVmax, SUVmean, SUVpeak, and tumor background ratio. More recently, other semi-quantitative methods, such as total lesion glycolysis and metabolic tumor volume, have been studied and demonstrated to be valuable both in identifying malignant tissue and assessing response to therapy. New technologies such as dual-phase PET/CT have also shown promise to be able to differentiate malignant from nonmalignant causes of FDG uptake. Summary: Although there are limitations to the existing studies including small sample sizes, differing cutoff points and the used variables, PET/CT has a clear role in helping to determine osteosarcoma disease prognosis, in conjunction with clinical data. Additional prospective and larger studies are needed to help assess how to best incorporate PET/CT into treatment optimization for osteosarcoma patients in the future.
- 18-F FDG PET/CT
- Metabolic imaging
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging