Diffuse skeletal uptake on ¹⁸F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography scan in a patient with acute lymphoblastic leukemia: A typical superscan pattern resembling naf positron emission tomography scan

Abstract

A 65-year-old patient with acute lymphoblastic leukemia presented for an 18fluoro-2-deoxy-d-glucose positron emission tomography computed tomography (18FDG PET) after several courses of chemotherapy for metastatic evaluation. Unexpectedly, on 18FDG PET scan, no discernible uptake was observed in the visceral organs, but instead, the skeleton/bone marrow showed homogenously intense metabolic activity. The distribution of 18FDG observed on the scan was remarkably similar to that on the NaF PET scan, indicating a superscan appearance.

Case report: 18F-FDG PET/CT skeletal superscan-like in an adult patient with acute lymphoblastic leukemia

“…The patient in our case died very soon. In the reported case of two ALL patients with superscan, one was reported dead two months after the PET/CT scan, suggestive of a considerably poor prognosis ( 16 ), while the outcome for the other was not reported. However, the sample was too small.…”

“…This feature “looks too good” due to the diffuse and symmetric skeletal uptake, similar to the appearance of a bone scan. To date, diffuse tracer uptake in the skeleton/bone marrow as a skeletal superscan pattern on 18 F-FDG PET/CT has been previously reported in hematological diseases (including two cases of multiple myeloma ( 12 , 13 ), two cases of lymphoma and two cases of acute lymphoblastic leukemia ( 6 , 14 – 16 ), and one case of hemophagocytic lymphohistiocytosis) ( 17 ), nine cases of solid tumors with extensive bone metastasis ( 11 , 18 – 25 ), and metabolic diseases with three cases of hyperparathyroidism and one case of renal osteodystrophy ( 26 – 29 ). By reviewing all the medical images of the reports, the hematological diseases revealed greater homogeneous radiotracer uptake in the skeleton, as in our case, and the metabolic diseases all had a specific skull and mandible intense uptake pattern.…”