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PET/CT Characterization of Fibroosseous Defects in Children: ¹⁸F-FDG Uptake Can Mimic Metastatic Disease

¹ Division of Diagnostic Imaging, Department of Radiological Sciences, MS 210, St. Jude Children's Research Hospital, 332 N Lauderdale St., Memphis, TN 38105-2794.
² Department of Radiology, University of Tennessee Health Science Center, Memphis, TN 38163.
³ Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163.

OBJECTIVE. The purpose of this study was to characterize the anatomic appearance and metabolic activity of nonossifying fibromas, fibrous cortical defects, and cortical desmoids on PET/CT images.

CONCLUSION. Over a 14-month period, we identified eight nonossifying fibromas, four fibrous cortical defects, and two cortical desmoids in 330 children who underwent PET/CT for the evaluation of a known or suspected malignancy. CT, conventional radiography, MRI, or clinical follow-up was used to confirm the diagnoses of these fibroosseous lesions. Eleven of the 14 children underwent multiple PET/CT examinations; thus, 34 studies were included. The lesions showed variable metabolic activity as indicated by ¹⁸F-FDG uptake: 19 PET/CT examinations showed lesions with mild ¹⁸F-FDG uptake, eight showed moderate ¹⁸F-FDG uptake, and seven showed intense uptake. When PET reveals metabolically active osseous abnormalities in children who are at risk for bone metastases, benign fibroosseous lesions should be considered in the differential diagnosis before additional diagnostic procedures are undertaken. Benign fibroosseous lesions may be metabolically active and thus mimic metastatic osseous disease in children with underlying malignancies. Correlative CT or other anatomic imaging can confirm the benign nature of these lesions.

Keywords: cortical desmoid • fibroosseous defects • fibrous cortical defect • nonossifying fibroma • nuclear imaging • pediatric imaging • PET/CT

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