Comparison of Cell Proliferation, Protein, and Glucose Metabolism in Musculoskeletal Tumors in a PET Study

¹¹C-choline and ¹⁸F-FAMT are known to correlate with tumor cell proliferation and amino acid metabolism. We investigated the ability of ¹¹C-Choline and ¹⁸F-FAMT PET in diagnosis of musculoskeletal tumors in thirty-six patients in comparison of ¹⁸F-FDG PET. ¹¹C-Choline and ¹⁸F-FDG PET were positive in all the malignant tumors (n = 13), whereas ¹⁸F-FAMT was positive in 11 tumors. The mean SUVs for malignant tumors were significantly higher than those for benign lesions in all three tracers imaging. A moderate correlation was found between ¹¹C-Choline and ¹⁸F-FDG (r = 0.540, P < .05), or ¹⁸F-FAMT and FDG (r = 0.596, P < .05). The diagnostic sensitivity and specificity for malignancy were 91.7% and 71.4%, respectively, using ¹¹C-choline with a SUV cut-off of 2.69. The sensitivity and specificity of ¹⁸F-FAMT for malignancy were 66.7% and 85.7%, respectively, using a SUV cut-off of 1.26. For ¹⁸F-FDG, using a SUV cut-off of 2.77, the sensitivity and specificity were 83.3% and 71.4%, respectively. According to ROC analysis, the ROC curves for ¹¹C-Choline, ¹⁸F-FAMT, and ¹⁸F-FDG were 0.855, 0.734, and 0.847, respectively. ¹¹C-Choline PET is superior in the visualization of musculoskeletal tumors with high contrast imaging, whereas the combination of ¹⁸F-FAMT and ¹⁸F-FDG PET provides valuable information for the preoperative planning in patients with musculoskeletal tumors.