False-positive FDG PET CT Scan in Vertebral Hemangioma

Document Type : Case report


1 Consultant Incharge, Dr Solav's SPECT Lab, India

2 Consultant Radiologist, Dr Solav's SPECT Lab

3 Consultant Radiologist, Dr Solav's SPECT Lab, Consultant Radiologist


FDG PET CT scan is considered to be a sensitive tool to detect skeletal metastasis in known malignancies. However, it’s high sensitivity and low specificity may account for false positive diagnosis in cases of trauma, infection, inflammation and other benign conditions. Skeletal hemangioma is one of the common benign conditions which are typically ametabolic on FDG PET CT with no uptake on bone scan. However, rarely they may have atypical imaging features and appear hypermetabolic. Other imaging modalities such as MRI and CT scan have typical imaging findings for hemangioma and can be used for evaluation of focal hypermetabolic skeletal lesions. There are atypical imaging characteristics in each of these modalities. Hence when used judiciously they can complement each other and avoid a false positive test result. This case report highlights the importance of bone scan and CT scan in excluding pathological involvement of skeleton with false positive FDG PET scan results.


Main Subjects

1. Pessaaud T. The polka-dot sign. Radiology. 2008; 246(3):980-1.
2. Pastushyn AI, Slinko EI, Mirzoveva GM. Vertebral hemangiomas: diagnosis, management, natural history and clinicoathological correlates in 86 patients. Surg Neurol. 1999;50(6):535-47.
3. Han BK, Ryu JS, Moon DH, Shin MJ, Kim YT, Lee HK. Bone SPECT imaging of vertebral hemangioma correlation with MR imaging and symptoms. Clin Nucl Med. 1995;20(10):916-21.
4. Gerard PS, Wilck E. Spinal hemangioma. An unusual photopenic presentation on bone scan. Spine. 1976;17(5):607-10.
5. Halkar RK, Motawi MM, Hebbar HG, Jahan MS. Vertebral body hemangioma showing increased uptake of Tc-99m MDP and decreased Tc-99m labeled red blood cells. Clin Nucl Med. 1994;19(9):827-8.
6. Raphael J, Hephzibah J, Mani S, Shanthly N, Oommen R. Abnormal appearance of spinal hemangioma mimicking metastasis in bone scintigraphy and SPECT CT: a case report. J Nucl Med Radiat Ther. 2013;S6:16-8.
7. Bybel B, Raja S. Vertebral hemangioma on FDG PET scan. Clin Nucl Med. 2003;28(6):522-3.
8. Nakayama M, Okizaki A, Ishitoya S, Aburano T. “Hot” vertebra on FDG PET scan; a case of vertebral hemangioma. Clin Nucl Med. 2012;37(12):1990-3.
9. Feldman F, van Heertum R, Manus C. 18FDG PET scanning of benign and malignant musculoskeletal lesions. Skeletal Radiol. 2003;32(4):201-8.
10. Kwee TC, de Klerk JMH, Nix M, Heggelman BGF, Dubois SV, Adams HJA. Benign bone conditions that may be FDG -avid and mimmic malignancy. Semin Nucl Med. 2017;47(4):322-51.
11. Itabashi T, Emori M, Terashima Y, Hasegawa T, Shimizu J, Nagoya S, et al. Hemangioma of the rib showing relatively high 18F-FDG uptake: a case report with a literature review. Acta Radiol Open. 2017;6(9):1-5.
12. Cha JG, Yoo JH, Kim HK, Park JM, Paik SH, Park SJ. PET/CT and MRI of intra-osseous hemangioma of the tibia. Br J Radiol. 2012;85(1012):e094-8.
13. Ko SW, Park JG. Cavernous hemangioma of the ilium mimmiking aggressive malignant bone tumor with increased activity on 18F-FDG/CT. Korean J Radiol. 2013;14(2):294-8.
14. Dupond JL, Mahammedi H, Prie D, Collin F, Gil H, Blagosklonov O, et al. Oncogenic osteomalacia: diagnostic importance of fibroblast growth factor 23 and F-18 FDG PET CT for the diagnosis and follow up in one case. Bone. 2005;36(3):375-8.
15. Weidner N, Santa Cruz D. Phosphaturic mesenchymal tumors. A polymorphous group causing osteomalacia or rickets. Cancer. 1987;59(8):1442-54.
16. Malhotra G, Agrawal A, Jambhekar NA, Sarathi V, Jagtap V, Agarwal MG, et al. Interesting image. The search for primary tumor in a patient with oncogenic osteomalacia: F-18 FDG PET resolves the conundrum. Clin Nucl Med. 2010;35(11):896-8.
17. Breer S, Brunkhorst T, Beil FT, Peldschus K, Heiland M, Klutmann S, et al. 68Ga DOTA-TATE PET/CT allows tumor localization in patients with tumorinduced osteomalacia but negative 111In-octreotide SPECT/CT. Bone. 2014;64:222-7.
18. Taira AV, Herfkens RJ, Gambhir SS, Quan A. Detection of bone metastases: assessment of integrated FDG PET/CT imaging. Radiology. 2007;243(1):204-11.