IJCEM Copyright © 2008-All rights reserved. Published by e-Century Publishing Corporation, Madison, WI 53711
Int J Clin Exp Med 2013;6(2):144-148

Case Report
Dual-time points 18F-FDG PET/CT imaging in detection of bone me-tastases from
hepatocellular carcinoma

Xueren Zhao, Alex Yi, George Ariza, Lee Salcido

Department of Radiology, Loma Linda VA Hospital, 11201 Benton Street, Loma Linda, California 92357, USA

Received November 13, 2012; Accepted December 27, 2012; Epub January 26, 2013; Published February 6, 2013

Abstract: Bone scan is a well-established imaging modality in detection of osseous metastasis. However, its sensitivity decreases at
evaluating lytic osseous metastasis in such entity as hepatocellular carcinoma (HCC). Increasingly, Fluorine-18 fluorodeoxyglucose
positron emission tomography (18F-FDG PET) with dual-time points imaging is utilized in detection of osseous metastasis from
hepatocellular carcinoma. We report a case of HCC presenting with a focal increased activity on bone scan corresponding to left distal
humeral fracture seen on an X-ray. Subsequent dual-time points 18F FDG PET/CT scan demonstrated interval increase in FDG activity
involving the left distal humeral fracture, favoring neoplastic, rather than post fracture inflammatory process, later biopsy proven to be
metastatic hepatocellular carcinoma. Several other FDG avid lesions were also found with interval increase in FDG activity on delayed
images, helping to narrow the differential diagnosis to osseous metastases as a cause. (IJCEM1211003).

Keywords: Hepatocellular carcinoma, bone metastases, bone scan, 18F-FDG PET/CT, dual-time points imaging

Address correspondence to: Dr. Xueren Zhao, Radiology of Loma Linda VA Hospital, 11201 Benton Street, Room 4E-15, Loma Linda,
Califor-nia 92357, USA. Phone: 909-8257084, ext 2669; Fax: 909-7773204; E-mail: xueren.zhao@va.gov