18F-Fluoride PET/CT Allows Detection of Hyperostosis and Osseous Involvement in Meningioma Initial Experience

Purpose: The present study was conducted to assess the diagnostic performance of F-18-fluoride PET/CT in evaluating hyperostosis and osseous involvement in patients with meningioma. Patients and Methods: Thirty-four patients with meningioma (mean age, 61 years) underwent F-18-fluoride PET/CT before surgery. In 24 patients (71%), F-18-FDG PET/CT was also given before surgery, and the results were compared. The images were reviewed by 2 board-certified nuclear medicine specialists who were unaware of any clinical information and a consensus was reached. Uptake patterns and measurements of tracers were compared with pathological findings from resected specimens, with hyperostosis and osseous involvement as the reference standard. Results: There were 27 grade I tumors (79%) and 7 grade II tumors (21%). The primary tumor focus was identified in each patient using both F-18-fluoroide PET/CT and F-18-FDG PET/CT, but there were no significant correlations in the degree of uptake between the 2 tracers. The SUVmax, SUVmax corrected for lean body mass (SULmax), and tumor metabolic volume (TMV) for F-18-fluoride and F-18-FDG were greater in grade II tumors than in grade I tumors. Hyperostosis and osseous involvement was identified in 12 tumors (38%). The SUVmax, SULmax, and TMV of tumors visualized with F-18-fluoride PET/CT were greater in tumors with hyperostosis and osseous involvement than in those without (P = 0.005, P = 0.003, and P = 0.006, respectively). In contrast, the SUVmax, SULmax, and TMV of tumors visualized with F-18-FDG PET/CT were similar regardless of hyperostosis or osseous involvement. Conclusions: F-18-fluoride PET/CT may improve detection of hyperostosis and osseous involvement in patients with meningioma.