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Background <p>Systematic data on <sup>18</sup>F-fluorodeoxyglucose positron emission tomography/computed tomography (<sup>18</sup>F-FDG PET/CT) in metastatic chordoma are scarce. This study aimed to evaluate its imaging characteristics and potential relevance to clinical assessment and management.</p> Methods <p>In this single-center retrospective analysis, 21 patients with pathologically confirmed chordoma and prior treatment underwent <sup>18</sup>F-FDG PET/CT for suspected recurrence or metastasis. Metastatic disease was diagnosed per a composite standard (biopsy, imaging progression, or characteristic multimodal findings). Relevant clinical and histopathological data were collected. Images were independently reviewed by two experienced nuclear medicine physicians for metabolic activity and whole-body disease assessment. They assessed metabolic activity at the primary site and performed whole-body evaluation. For each metastatic lesion, maximum standardized uptake value (SUVmax) and size were measured; CT features were also documented. Interobserver agreement for key assessments was formally evaluated.</p> Results <p>Metastatic disease was identified in 11 of 21 patients (52.4%). Metastases were found in bone (7 patients), soft tissue (8 patients), and lung (5 patients). Site-specific metabolic patterns emerged: pulmonary metastases had lower FDG avidity (median SUVmax 2.3) correlated with size, whereas bone and soft-tissue avidity (SUVmax 3.8–3.9) was size-independent. Notably, in 4 out of 21 patients (19.0%), PET/CT detected metastases outside the field of view of conventional imaging. Interobserver agreement was perfect for metastatic status and excellent for total lesion counts. A case illustrated differential treatment response linked to baseline metabolic avidity.</p> Conclusions <p><sup>18</sup>F-FDG PET/CT offers a reproducible whole-body assessment for chordoma, enabling the detection of occult metastases and revealing metabolic heterogeneity of potential clinical relevance. These hypothesis-generating findings suggest a potential role in surveillance and personalized management, warranting further prospective validation before clinical implementation.</p>

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18F‑FDG PET/CT in metastatic chordoma: a retrospective analysis of imaging features and potential clinical relevance

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月26日

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  • Le Song,
  • Peilin Hua,
  • Feng Wei,
  • Weifang Zhang

摘要

Background

Systematic data on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in metastatic chordoma are scarce. This study aimed to evaluate its imaging characteristics and potential relevance to clinical assessment and management.

Methods

In this single-center retrospective analysis, 21 patients with pathologically confirmed chordoma and prior treatment underwent 18F-FDG PET/CT for suspected recurrence or metastasis. Metastatic disease was diagnosed per a composite standard (biopsy, imaging progression, or characteristic multimodal findings). Relevant clinical and histopathological data were collected. Images were independently reviewed by two experienced nuclear medicine physicians for metabolic activity and whole-body disease assessment. They assessed metabolic activity at the primary site and performed whole-body evaluation. For each metastatic lesion, maximum standardized uptake value (SUVmax) and size were measured; CT features were also documented. Interobserver agreement for key assessments was formally evaluated.

Results

Metastatic disease was identified in 11 of 21 patients (52.4%). Metastases were found in bone (7 patients), soft tissue (8 patients), and lung (5 patients). Site-specific metabolic patterns emerged: pulmonary metastases had lower FDG avidity (median SUVmax 2.3) correlated with size, whereas bone and soft-tissue avidity (SUVmax 3.8–3.9) was size-independent. Notably, in 4 out of 21 patients (19.0%), PET/CT detected metastases outside the field of view of conventional imaging. Interobserver agreement was perfect for metastatic status and excellent for total lesion counts. A case illustrated differential treatment response linked to baseline metabolic avidity.

Conclusions

18F-FDG PET/CT offers a reproducible whole-body assessment for chordoma, enabling the detection of occult metastases and revealing metabolic heterogeneity of potential clinical relevance. These hypothesis-generating findings suggest a potential role in surveillance and personalized management, warranting further prospective validation before clinical implementation.