How do we evaluate positive focus in the bone that shows no morphological changes in patients with malignant tumor history?

“It depends very much on the location and patient history, but also on the avidity of the hot-spot. If a patient had a solitary intensely FDG-avid focus in a vertebral body (centrally) or in a pelvic bone (e.g. right or left pubic bone), I would most likely report it as suspicious for malignancy, even if there was no morphological changes on CT. However, if a patient had 2-3 foci on adjacent ribs I would be less worried.”

Dr. Barbara Malene Fischer
London, UK

Question submitted during the the Conference on Hybrid Imaging Live 2019 regarding Dr. Fischer’s lecture on “18F-FDG PET/CT in oncology – basic considerations”