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The Cause and Clinical Significance of Central Tumor Photopenia on Thallium Scintigraphy of Pediatric Osteosarcoma of the Extremity

M. Beth McCarville1, Ellen H. Barton1,2, Jason R. Cameron1,3, Xiaoping Xiong4, Najat C. Daw5, Sue C. Kaste1, Shenjie Wu4, John O. Glass1 and Wilburn E. Reddick1

1 Department of Radiological Sciences, Division of Diagnostic Imaging, St. Jude Children's Research Hospital, 332 N Lauderdale St., Memphis, TN 38105-2974.
2 Present address: Methodist University Hospital, Memphis, TN.
3 Present address: Abercrombie Radiological Consultants, Knoxville, TN.
4 Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN.
5 Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN


Figure 1
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  		Fig. 1 —Lateral projection image obtained during thallium-201 (201Tl) scintigraphy of distal femoral osteosarcoma shows central photopenia, defined as photopenic center surrounded by 201Tl activity.

 

Figure 2
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  		Fig. 2 —Anteroposterior radiograph shows dense central tumor ossification in proximal humeral osteosarcoma of 13-year-old boy; this finding is postulated cause of central photopenia on thallium-201 scintigraphy.

 

Figure 3
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  		Fig. 3A —12-year-old boy with osteosarcoma of distal tibia. Anteroposterior radiograph shows primary tumor.

 

Figure 4
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  		Fig. 3B —12-year-old boy with osteosarcoma of distal tibia. Two reviewers visually divided each tumor into inner half and outer half as indicated by regions of interest (ROIs) (circled areas) shown. Each reviewer estimated percentage of ossification in inner and outer halves of tumor. Discrepancies of more than 10% between reviewers were resolved by principal investigator.

 

Figure 5
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  		Fig. 3C —12-year-old boy with osteosarcoma of distal tibia. Axial conventional contrast-enhanced T1-weighted MR image obtained through primary tumor.

 

Figure 6
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  		Fig. 3D —12-year-old boy with osteosarcoma of distal tibia. Two reviewers visually divided each tumor into inner and outer halves as indicated by ROIs (circled areas). Each reviewer estimated percent enhancement within each ROI. Discrepancies of more than 10% between reviewers were resolved by principal investigator.

 

Figure 7
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  		Fig. 4A —13-year-old girl with distal femoral osteosarcoma. Baseline coronal T1-weighted image obtained before contrast administration during dynamic contrast-enhanced MRI shows unenhanced primary tumor.

 

Figure 8
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  		Fig. 4B —13-year-old girl with distal femoral osteosarcoma. Coronal dynamic contrast-enhanced MR image obtained at peak contrast enhancement shows tumor.

 

Figure 9
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  		Fig. 4C —13-year-old girl with distal femoral osteosarcoma. Image shown in B with regions of interest (circled areas) outlining inner and outer halves of tumor. Tumor periphery was outlined by radiologist. Computer software then divided tumor area into inner and outer halves, and dynamic vector magnitude (measure of both initial rate of contrast uptake and maximum contrast enhancement) and kep (measure of exchange rate of contrast agent between plasma and extracellular fluid space) for these regions were determined.

 

Figure 10
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  		Fig. 5 —Graph shows Kaplan-Meier survival estimates of young (age, < 13 years) patients with central tumor photopenia on thallium-201 scintigraphy (thin line, n = 17) compared with that of young patients without central tumor photopenia (thick line, n =10).

 

Figure 11
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  		Fig. 6 —Graph shows Kaplan-Meier survival estimates of older patients (age, ≥ 13 years) with central tumor photopenia on thallium-201 scintigraphy (thin line, n = 16) compared with that of older patients without central tumor photopenia (thick line, n =14).

 

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