title: The cause and clinical significance of central tumor photopenia on thallium scintigraphy of pediatric osteosarcoma of the extremity.
abstract: OBJECTIVE
  The objectives of our study were to determine whether central tumor photopenia on thallium-201 (201Tl) scintigraphy of primary osteosarcoma results from central tumor necrosis or dense central tumor ossification and to determine the relation of this finding to tumor response to chemotherapy and to patient survival.
  
  
  METHODS
  After the institutional review board approved our study and waived the need for patient or parental consent, two radiologists independently reviewed 201Tl scans, conventional radiographs, and MR images of 57 patients obtained at diagnosis of extremity primary nonmetastatic osteosarcoma to detect the presence of central tumor photopenia on 201Tl scintigraphy and estimate outer tumor ossification versus inner tumor ossification and enhancement. The dynamic enhanced MRI parameters dynamic vector magnitude (DVM) and k(ep) (measure of the exchange rate between plasma and extracellular fluid space) were compared for outer tumor versus inner tumor, and the relation among 201Tl scintigraphy, conventional radiography, MRI, and the dynamic enhanced MRI parameters was analyzed. We examined whether central tumor photopenia on 201Tl imaging was related to histologic response or to patient survival.
  
  
  RESULTS
  Thirty-three patients (58%) had central tumor photopenia on 201Tl imaging that was not associated with central tumor ossification (p = 0.8) or with the difference between outer tumor and inner tumor contrast enhancement (p = 0.4). Central tumor photopenia on 201Tl scintigraphy was significantly associated with an increasing difference between outer tumor DVM and inner tumor DVM (i.e., outer tumor DVM minus inner tumor DVM) (p = 0.05), an increasing difference between outer tumor k(ep) and inner tumor k(ep) (i.e., outer k(ep) minus inner k(ep)) (p = 0.01), and an increasing outer k(ep)-inner k(ep) ratio (p = 0.02). We found no relation between central tumor photopenia and histologic response (p > or = 0.2). Older patients (age, > or = 13 years) with central tumor photopenia were least likely to survive, whereas younger patients (age, < 13 years) without central tumor photopenia were most likely to survive (p = 0.07).
  
  
  CONCLUSIONS
  Central tumor photopenia on 201Tl scintigraphy of primary osteosarcoma is unlikely to reflect central ossification but may be due to central necrosis reflected by higher outer tumor DVM and k(ep) than inner tumor DVM and k(ep) and may be negatively associated with survival in older patients. Prospective studies are needed to determine the value of this information in planning treatment.
authors.affiliation: Department of Radiological Sciences, Division of Diagnostic Imaging, St. Jude Children's Research Hospital, 332 N Lauderdale St., Memphis, TN 38105-2974, USA. Beth.McCarville@stjude.org
authors.forename: M Beth
authors.initials: MB
authors.lastname: McCarville
authors.forename: Ellen H
authors.initials: EH
authors.lastname: Barton
authors.forename: Jason R
authors.initials: JR
authors.lastname: Cameron
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Xiong
authors.forename: Najat C
authors.initials: NC
authors.lastname: Daw
authors.forename: Sue C
authors.initials: SC
authors.lastname: Kaste
authors.forename: Shenjie
authors.initials: S
authors.lastname: Wu
authors.forename: John O
authors.initials: JO
authors.lastname: Glass
authors.forename: Wilburn E
authors.initials: WE
authors.lastname: Reddick
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D005121:Extremities / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D012516:Osteosarcoma / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013793:Thallium
chemical_list: D019275:Radiopharmaceuticals; C027549:thallium chloride; D013793:Thallium