Evaluation of hemangioma by positron emission tomography: role in a multimodality approach.
OBJECTIVE
The relative utility of various preoperative diagnostic imaging modalities for the evaluation of hemangioma of the extremities, including positron emission tomography (PET) (using 18F-fluoro-2-deoxy-D-glucose [FDG] and fluorine-18 alpha-methyltyrosine [FMT]), computed tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA), was investigated.


METHODS
Imaging findings in 16 patients with 16 histopathologically documented hemangiomas of the extremities were retrospectively reviewed. Preoperative imaging included: FDG-PET (n = 16), FMT-PET (n = 12), MRI (n =16), CT (n =11), and DSA (n =14).


RESULTS
All 16 lesions examined by PET with FDG and/or FMT showed accumulation. The standardized uptake values (SUVs) for FDG-PET for the 16 examined tumors ranged from 0.7 to 1.67; for FMT-PET, they ranged from 0.14 to 1.00. The SUVs with both tracers indicated the benign nature of the tumor. Computed tomography demonstrated variable attenuation and phleboliths in two patients. The MRI signal characteristics were relatively consistent: heterogeneous signals were slightly higher than those of skeletal muscle on T1-weighted images and brighter than those of subcutaneous fat on T2-weighted images. The pooling and cotton-wool staining depicted in DSA was found to be significantly correlated with FDG accumulation, suggesting that localized blood retention-induced ischemia may accelerate anaerobic glycolysis, which leads to high FDG uptake.


CONCLUSIONS
Although plain radiography, CT, MRI, and angiography may provide anatomic extent and be pathognomonic, FDG-PET and FMT-PET may be the most reliable among the studied imaging modalities for differentiating benign hemangiomas from other soft tissue tumors, especially malignant neoplasms.
Hatayama
Kazuhisa
K
Department of Orthopedic Surgery, Gunma University Faculty of Medicine, Maebashi, Japan.
Watanabe
Hideomi
H
Ahmed
Adel Refaat
AR
Yanagawa
Takashi
T
Shinozaki
Tetsuya
T
Oriuchi
Noboru
N
Aoki
Jun
J
Takeuchi
Kimihiko
K
Endo
Keigo
K
Takagishi
Kenji
K
D000293:Adolescent; D000328:Adult; D015901:Angiography, Digital Subtraction; D002648:Child; D005121:Extremities / Q000000981:diagnostic imaging; D005260:Female; D019788:Fluorodeoxyglucose F18; D006391:Hemangioma / Q000175:diagnosis / Q000000981:diagnostic imaging*; D006392:Hemangioma, Cavernous / Q000175:diagnosis / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18