Comparison of Cell Proliferation, Protein, and Glucose Metabolism in Musculoskeletal Tumors in a PET Study

(11)C-choline and (18)F-FAMT are known to correlate with tumor cell proliferation and amino acid metabolism. We investigated the ability of (11)C-Choline and (18)F-FAMT PET in diagnosis of musculoskeletal tumors in thirty-six patients in comparison of (18)F-FDG PET. (11)C-Choline and (18)F-FDG PET were positive in all the malignant tumors (n = 13), whereas (18)F-FAMT was positive in 11 tumors. The mean SUVs for malignant tumors were significantly higher than those for benign lesions in all three tracers imaging. A moderate correlation was found between (11)C-Choline and (18)F-FDG (r = 0.540, P < .05), or (18)F-FAMT and FDG (r = 0.596, P < .05). The diagnostic sensitivity and specificity for malignancy were 91.7% and 71.4%, respectively, using (11)C-choline with a SUV cut-off of 2.69. The sensitivity and specificity of (18)F-FAMT for malignancy were 66.7% and 85.7%, respectively, using a SUV cut-off of 1.26. For (18)F-FDG, using a SUV cut-off of 2.77, the sensitivity and specificity were 83.3% and 71.4%, respectively. According to ROC analysis, the ROC curves for (11)C-Choline, (18)F-FAMT, and (18)F-FDG were 0.855, 0.734, and 0.847, respectively. (11)C-Choline PET is superior in the visualization of musculoskeletal tumors with high contrast imaging, whereas the combination of (18)F-FAMT and (18)F-FDG PET provides valuable information for the preoperative planning in patients with musculoskeletal tumors.