Analysis of Imaging Characteristics of F-18-FDG PET/CT in Misdiagnosed Bone Tuberculosis: A Report of 12 Cases

Objective: To analyze the imaging characteristics of F-18-fluorodeoxyglucose positron emission tomography/computer tomography (F-18-FDG PET/CT) in 12 cases of misdiagnosed bone tuberculosis so as to explore the differential diagnostic method with metastatic bone tumors. Methods: The images of 12 patients with bone tuberculosis diagnosed by F-18-FDG PET/CT were retrospectively analyzed. Distribution of lesion locations in the whole body and characteristics of glucose metabolism were analyzed by qualitative and semi-quantitative methods, especially for bone lesion location, number and range, glucose uptake form and CT imaging characteristics, and the maximum of standardized uptake value (SUVmax) was measured and recorded. Results: Of 12 patients, 1 showed increased glucose uptake of diffuse bone marrow in the whole body, whereas the rest suffered from 19 bone lesions, in which each one had 1 bone lesion in 9 cases, accounting for 75.0%. The images of PET/CT in 12 patients primarily manifested annular or nonuniform increase of glucose uptake (63.2%), sequestrum within osteolytic lesions (31.6%), injured intervertebral disc caused by vertebral lesions (61.5%) and cold abscesses around the lesions (68.4%). The glucose uptake rate of cold abscesses was higher than that of bone lesion locations. The tuberculosis complicated with other parts included lymphatic tuberculosis (100.0%), pulmonary tuberculosis (66.7%), pericardial or pleural tuberculosis (25.0%) and hepatolienal tuberculosis (8.3%). Conclusion: The characteristics of bone tuberculosis lesions are prominent in F-18-FDG PET/CT imaging, which could contribute to diagnosis of whole body tuberculosis and has a greater value in the differentiation of bone tuberculosis and metastatic bone tumors.