whole body CT Scans are negative: is it good idea to proceed with PET Scan?
Hello Dr Ahmed Bakhsh
I would advise that PET scan (and I am assuming you mean with FDG) is a good idea because it may help establish staging (such as with other sites involved) but to establish the exact aetiology often requires histopathology/biopsy.
Another important consideration is the size of the lesion. If it is too small, it might not be reliably characterised by the scanner used. Suggest, please, check what (scanner) is available. It is often different at different sites.
It is discussed in this article:
Article Fundamental Limits of Spatial Resolution in PET
if you talk about solitary skull lesion detected in usual and negative whole-body CT , please ask the radiologist if it carries being or malignant criteria, size and extensions, if there is an intracranial extension or not, bone defects relation to sutures if present, most common lesions in the skull may be begin like hemangioma in which PET CT is a waste.
A malignant lesion in the skull or an undefined lesion is considered primary, and in my opinion, the second step is an MRI and then a biopsy. PET CT, an expensive tool, is useful in detecting the activity of the lesion and the presence of undefined metastatic deposits anywhere in the body. Whole-body MRI with diffuse is more or less an alternative to PET CT if a well-trained radiologist is available.
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