A bone marrow F-18 FDG uptake exceeding the liver uptake may indicate bone marrow hyperactivity

Inoue, Kentaro; Goto, Ryoi; Okada, Ken; Kinomura, Shigeo; Fukuda, Hiroshi

doi:10.1007/s12149-009-0286-9

Cited by 88 publications

(79 citation statements)

References 24 publications

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“…These data were concordant with the results of Inoue et al, who suggested that a FDG BMU greater than or equal to that of the liver indicates BM activation, and that the most likely cause is inflammation [29]. These results are also concordant with those previously reported at initial staging of Hodgkin lymphoma (HL), despite the fact that DLBCL is a less inflammation provider disease than HL [14].…”

Section: Discussionsupporting

confidence: 91%

FDG PET/CT for Initial Staging of Diffuse Large B-Cell Lymphoma: Is Diffuse Bone Marrow Uptake a Reflection of Disease Involvement?

Keromnes¹,

Roux²

2016

J Bone Marrow Res

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Objectives: Bone marrow assessment is a diagnostic challenge in staging diffuse large B-cell lymphoma (DLBCL). Diffuse bone marrow uptake (BMU) can be observed on FDG PET/CT performed for initial staging of DLBCL, but remains difficult to analyze. The aim of this study was to evaluate the meaning of this diffuse BMU, and especially to assess its correlation with bone marrow involvement (BMI). Methods:Patients who underwent FDG PET/CT for initial staging of DLBCL were analyzed. Diffuse BMU was assessed using a visual qualitative analysis according to liver uptake (grade 1=below liver uptake, 2=equal to liver uptake, 3=above liver uptake), and a semi-quantitative analysis, by measurement of maximum standardized uptake value (SUV) in the sacral promontory. We compared the BMU with BMI, parameters of disease extension and inflammatory markers.Results: 86 patients (median age 59, range: 19-91, 54 men, 32 women) were included. BMU grade was 1, 2 and 3 in 45, 28 and 13 cases respectively. Bone marrow was considered involved in 13 patients. No statistical correlation was found between diffuse BMU and BMI, using qualitative (p=0.594) or semi-quantitative method (p=0.116). Diffuse BMU visual grading was correlated with inflammatory markers: biological systemic symptoms (p=0.003), CRP (p=0.002) and fibrinogen (p=0.020). Conclusions:Our study suggests that a diffuse BMU seen on FDG PET/CT at initial staging of DLBCL is not representative of bone marrow involvement, but can be due to inflammatory changes.

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Section: Discussionsupporting

confidence: 91%

FDG PET/CT for Initial Staging of Diffuse Large B-Cell Lymphoma: Is Diffuse Bone Marrow Uptake a Reflection of Disease Involvement?

Keromnes¹,

Roux²

2016

J Bone Marrow Res

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“…18 F]-FDG PET was not predictive of BM pathology [12,13,16,[19][20][21][22][23][24]. This is also our point of view and we believe that it should be �� MIP and axial images from a 35 year old male shows focal FDG uptake at the lower thoracic spine.…”

Section: Discussionmentioning

confidence: 91%

“…Discordant findings were associated to worse outcomes only if the BM biopsy (BM b ) was positive [13]. The utility of FDG PET-CT in evaluating BM involvement has also been explored by other authors with variable results as to its benefit [6,7,[12][13][14][15][16][17][18][19][20][21][22][23]. Because FDG PET-CT's are performed routinely now in the pretherapy staging of most lymphoma patients, extracting noninvasively additional information in regards to bone marrow status would be very valuable.…”

Section: Introductionmentioning

confidence: 99%

Pre-Treatment FDG PET Bone Marrow (BM) Uptake and Disease Involvement. Can Semiquantitative Measures Discriminate Between A Normal, Hypercellular or Infiltrated Bone Marrow?

Ahmed¹,

Yao²,

Fourzali

et al. 2013

J Bone Marrow Res

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PET studies are used on a regular basis to stage lymphoma patients pretreatment. Bone marrow uptake (BM u ) can be associated with disease involvement, however occasionally uptake is related to benign etiologies (anemia, stimulation, a hypercellular marrow etc…). Uncovering quantitative and qualitative parameters to elucidate the etiology of (BM u ) may help the radiologist and oncologist in cases where a BM biopsy (BM b ) cannot be performed or interpreted by the pathologist or is unavailable. We looked retrospectively at a group of consecutive lymphoma patients (pts) who had an initial staging PET scan. Out of 121 patients, 36 had a (BM b ) report available for review. We attempted to evaluate whether semi quantitative parameters -maximum standardized uptake value (SUVm); Average SUV (SUVav); SUVm/Mediastinal blood pool (MBP) ratio -could discriminate between different bone marrow patterns (normal, hypercellular, positive). We also looked at the type of BM u (none; mild; prominent) and pattern (patchy; diffuse; focal). The average age of our patient population was 52.19. 66.66% were males (24/36). Most of our patient's had a normal BM b . 25 % (9/36) had a positive BM. In the BM positive group, no pts had patchy uptake and 2 pts were found to have no appreciable uptake. In the BM normal group 71.5 % (15/21) had either mild or prominent uptake and only 28.5% had no uptake. None had focal uptake and 90% of pts had diffuse uptake. The majority of whole cohort had a SUVm> 2.5: 90 % of BM normal; 100% of hypercellular BM and 88.88% of the BM positive group and an SUVm/MBP>2.5: 52.4%; 66.66% and 55.5% respectively. Using a Chi-square test BM Pathology level was overall significantly different across the BM u patterns (p=0.0192). Analysis looking at BM positive versus BM negative groups, shows BM pattern is no longer a significant variable to predict BM pathology (p=0.168). Subsequently, the odds ratio of having only positive BM pathology based on focal vs. patchy pattern is not significant. Conclusion:No qualitative or semi quantitative parameters were found to be statistically significantly associated with BM pathology. Further exploration in a larger cohort is necessary.

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“…There was mild and diffuse increase of FDG uptake in the bone marrow with a maximum standard uptake value of 2.5 in the spines, which was similar to the FDG uptake in the liver. According to a study by Inoue et al, 14 a bone marrow F-18 FDG uptake greater than or equal to that of the liver may indicate bone marrow hyperactivity. Therefore, bone marrow involvement could not be ruled out in this case.…”

Section: Discussionmentioning

confidence: 98%

Application of Fluorine-18-Deoxyglucose Positron Emission Tomography and Gallium Scan for Assessment in a Patient With Adult-Onset Still's Disease

2016

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A bone marrow F-18 FDG uptake exceeding the liver uptake may indicate bone marrow hyperactivity

Abstract: The BM F-18 FDG uptake depends on the patient's age and serum CRP level, both with and without malignancy. A BM F-18 FDG uptake greater than or equal to that of the liver may indicate BM activation.

Cited by 88 publications

References 24 publications

FDG PET/CT for Initial Staging of Diffuse Large B-Cell Lymphoma: Is Diffuse Bone Marrow Uptake a Reflection of Disease Involvement?

FDG PET/CT for Initial Staging of Diffuse Large B-Cell Lymphoma: Is Diffuse Bone Marrow Uptake a Reflection of Disease Involvement?

Pre-Treatment FDG PET Bone Marrow (BM) Uptake and Disease Involvement. Can Semiquantitative Measures Discriminate Between A Normal, Hypercellular or Infiltrated Bone Marrow?

Application of Fluorine-18-Deoxyglucose Positron Emission Tomography and Gallium Scan for Assessment in a Patient With Adult-Onset Still's Disease

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