Characterizing bone marrow involvement in Hodgkin’s lymphoma by FDG-PET/CT

Abstract

FDG-PET/CT demonstrated BMI in 15% of patients with newly diagnosed HL. Diagnosis of BMI in HL by FDG-PET/CT was more sensitive than iBMB with potential upstage in 11% of patients. The most common pattern of FDG-PET/CT BMI was multifocal (at least three foci) skeletal FDG uptake, with at least one focus in the pelvis or vertebrae and no corresponding CT lesions.

Prognostic Value of Bone Marrow Tracer Uptake Pattern in Baseline PET Scans in Hodgkin Lymphoma: Results from an International Collaborative Study

“…This discrepancy is probably accounted by the thorough imaging review in our study, whereas in other studies data were based on nuclear medicine reports only. Consistent with previous literature (9,12,14,23), the results of this study confirm a clear correlation between strong diffuse BM uptake and some clinical parameters, such as lower hemoglobin level and higher leukocyte count. In this patient group, we also frequently noticed a strong diffuse uptake in the spleen, younger age, bulky disease, and lower levels of albumin compared with patients with no 18 F-FDG uptake in BM.…”

“…In the present analysis of 180 patients with treatment-naïve HL, we first gave a detailed description of BM 18 F-FDG uptake patterns to provide helpful key points for BMI assessment in PET/CT-staged patients. The significance of pure strong diffuse BM uptake is still unknown, but probably not related to BMI by neoplastic tissue, as recently stressed (8,12). Moreover, we confirmed that BMB is not a clinically relevant diagnostic tool, because of its scarce sensitivity and low likelihood to upstage PET/CT-staged patients (no patient upstaged from limited to advanced stage by BMB), thus far confirming that in the PET era BMB can be safely omitted for HL staging (8,19,20).…”

“…The sensitivity of PET for BMI was indeed suboptimal in our study (84%), and this finding, though not influential on treatment decision, should be taken into account during patient restaging in the case of resistant or relapsing lymphoma. When either a positive BMB or focal BM lesions on PET/CT that disappear during treatment in the following scans or both is considered as the standard reference for BMI by HL, as previously suggested (10,12), this is a more accurate method than BMB alone, because of the inability of BMB to detect BMI for the patchy nature of BM infiltration by HL. As a matter of fact, in our study only 12 of 180 patients (6.6%) had a positive BMB, whereas, predictably, most focal lesions recorded at baseline (86.8%) disappeared in the interim PET, in keeping with the negativization rate of interim PET in ABVD-treated HL (80%-85%) (25).…”

“…Many studies have shown a superior diagnostic sensitivity of PET/CT for bone marrow involvement (BMI) assessment over BMB, because the latter often fails to detect patchy BMI (4,(9)(10)(11). It is generally accepted that focally increased 18 F-FDG uptake in the BM with or without the presence of CT abnormalities is a sign of BMI, but the prognostic relevance of this finding is controversial (8,12). However, some patients display a diffuse baseline BM 18 F-FDG uptake with an intensity superior to that in the liver.…”

Role of 2-Deoxy-2-[18F]-fluoro-d-glucose-PET/Computed Tomography in Lymphoma

“…27 51 FDG-PET/CT and BMB have a high concordance rate (w80%) for detecting bone marrow involvement. [48][49][50]52,53 In discordant cases of a positive PET scan and negative BMB, the most common causes are sampling error and diffuse uptake due to reactive marrow (Fig. 4).…”