The Role of Positron Emission Tomography Imaging in Primary Bone Tumors: A Narrative Review

Purpose or Learning Objective: This narrative review summarizes the available literature on the usefulness of positron emission tomography imaging in managing primary bone tumors such as osteosarcoma, chondrosarcoma, and Ewing's sarcoma.

Methods or Background: Primary malignant bone tumors can pose significant diagnostic and therapeutic challenges due to intertumor heterogeneity. Although traditional imaging modalities such as radiography, magnetic resonance imaging, and computed tomography remain essential for initial evaluation and staging, emerging evidence underscores the evolving role of positron emission tomography, particularly positron emission tomography/computed tomography with 18F-fluorodeoxyglucose, in the comprehensive management of bone sarcomas.

Results or Findings: We highlight the potential of positron emission tomography/computed tomography as a powerful noninvasive tool for early response assessment in osteosarcoma that could inform timely treatment adjustments and optimize patient outcomes. Positron emission tomography scanning, especially in combination with conventional anatomical imaging, has emerged as a useful tool in diagnosing, staging, and monitoring chondrosarcomas. A central analysis of Ewing's sarcoma demonstrated that positron emission tomography/computed tomography outperformed bone marrow biopsy in detecting bone marrow involvement with diffuse fluorodeoxyglucose uptake, accurately capturing age-related changes in bone marrow, and identified further bone metastases with focal fluorodeoxyglucose uptake and cortical destruction undetected by biopsy.

Conclusion: Despite limitations like inconsistencies in standard uptake value cutoffs and reduced pulmonary resolution, positron emission tomography/computed tomography is valuable for staging, assessing response to neoadjuvant chemotherapy, predicting histologic outcomes, detecting recurrence, and guiding biopsy in metabolically active tumor sites. Further large-scale prospective studies are warranted to standardize protocols and establish the definitive role of positron emission tomography in sarcoma management.

Publication History

Article published online:
02 June 2025