Advances in ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography for soft tissue sarcomas

Soft tissue sarcomas (STS) are rare malignant tumors originating from mesodermal tissues with a poor prognosis, accounting for approximately 1% of all malignancies and comprising around 50 distinct subtypes. Conventional imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), primarily provide anatomical information, whereas 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) integrates functional metabolic and anatomical imaging, serving as a critical complementary tool in the diagnosis and management of STS. This article reviews recent advances in the application of 18F-FDG PET/CT for STS. The advantages of 18F-FDG PET/CT in STS include: (1) Early detection of metabolic activity changes in tumors, particularly when morphological alterations are insignificant; (2) Effective differentiation between benign and malignant soft tissue tumors, as well as aiding in distinguishing high-grade from low-grade sarcomas; (3) Identification of occult metastatic lesions, improving staging accuracy, and facilitating restaging in cases of recurrence or metastasis; (4) Utilization of parameters such as maximum standardized uptake value and metabolic tumor volume to assist in tumor grading and prognostic evaluation; and (5) Monitoring treatment response to guide adjustments in personalized therapeutic strategies. However, 18F-FDG PET/CT has limitations in diagnosis of certain STS subtypes (e.g. , myxoid liposarcoma), detection and biopsy of metastatic lymph nodes, necessitating integration with clinical evaluation and other imaging techniques. 18F-FDG PET/CT is poised to play an increasingly vital role in the precision diagnosis and treatment of STS.