Evaluation of physiological FDG uptake in the skeleton in adults: Is it uniformly distributed?

Aras, Mustafa; Dede, Fuat; Öneş, Tunç; İnanır, Sabahat; Erdıl, Tanju Yusuf; Turoğlu, Halil Turgut

doi:10.1016/j.remn.2014.03.007

Cited by 5 publications

(9 citation statements)

References 14 publications

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“…The different FDG uptake patterns in the four regions of the whole spine may be explained by the amount and component of bone marrow. However, a previous study reported that concerning the vertebral column, the SUVmax gradually increased from cervical to lumbar spine (C3 ¼ 2.2 AE 0.4, L3 ¼ 2.9 AE 0.7, P < 0.05) (9). Indeed, it was not appropriate to obtain the SUVmax of only six vertebral bodies including C3, C5, T3, T7, L1, and L3 to demonstrate the change of FDG uptake in the whole spine (9).…”

Section: Discussionmentioning

confidence: 83%

“…However, a previous study reported that concerning the vertebral column, the SUVmax gradually increased from cervical to lumbar spine (C3 ¼ 2.2 AE 0.4, L3 ¼ 2.9 AE 0.7, P < 0.05) (9). Indeed, it was not appropriate to obtain the SUVmax of only six vertebral bodies including C3, C5, T3, T7, L1, and L3 to demonstrate the change of FDG uptake in the whole spine (9). In addition, although several well-known factors affecting the physiological bone marrow FDG uptake such as radiochemotherapy, hematologic disorders or infection were excluded during patient enrollment, the included patients were all cancer patients and the cancer condition might have potential influences on the activity of bone marrow (9).…”

Section: Discussionmentioning

confidence: 83%

“…Indeed, it was not appropriate to obtain the SUVmax of only six vertebral bodies including C3, C5, T3, T7, L1, and L3 to demonstrate the change of FDG uptake in the whole spine (9). In addition, although several well-known factors affecting the physiological bone marrow FDG uptake such as radiochemotherapy, hematologic disorders or infection were excluded during patient enrollment, the included patients were all cancer patients and the cancer condition might have potential influences on the activity of bone marrow (9). A decrease of bone marrow FDG uptake with advancing age has been reported at several anatomical sites including the humerus, femur, rib, sternum, vertebral column, and pelvic bones (7)(8)(9)11,12).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, although several well-known factors affecting the physiological bone marrow FDG uptake such as radiochemotherapy, hematologic disorders or infection were excluded during patient enrollment, the included patients were all cancer patients and the cancer condition might have potential influences on the activity of bone marrow (9). A decrease of bone marrow FDG uptake with advancing age has been reported at several anatomical sites including the humerus, femur, rib, sternum, vertebral column, and pelvic bones (7)(8)(9)11,12). Blebea et al first demonstrated that there was a statistically significant but weakly correlated trend between SUVmax of L5 vertebra and increasing age for women and men with r of À0.44 and À0.39, respectively (7).…”

Section: Discussionmentioning

confidence: 99%

“…During imaging interpretation, a thorough understanding of FDG appearance of normal bone marrow, including distribution pattern and metabolic activity, is essential to accurately evaluate abnormal findings (7). Several studies have been published regarding this topic; however, apparent limitations were noted that all the included patients were cancer patients and only a few vertebrae were analyzed (7)(8)(9). Therefore, the aim of the current study was to determine physiological FDG bio-distribution of bone marrow in the whole vertebral column in healthy adults.…”

Section: Introductionmentioning

confidence: 99%

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Physiological uptake of 18F-FDG in the vertebral bone marrow in healthy adults on PET/CT imaging

Shen

Liang

et al. 2018

Acta Radiol

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Physiological uptake of 18F-FDG in the vertebral bone marrow in healthy adults on PET/CT imaging

Shen

Liang

et al. 2018

Acta Radiol

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Application of an artificial intelligence-based tool in [18F]FDG PET/CT for the assessment of bone marrow involvement in multiple myeloma

Sachpekidis

Enqvist

Ulén³

et al. 2023

Eur J Nucl Med Mol Imaging

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Purpose [18F]FDG PET/CT is an imaging modality of high performance in multiple myeloma (MM). Nevertheless, the inter-observer reproducibility in PET/CT scan interpretation may be hampered by the different patterns of bone marrow (BM) infiltration in the disease. Although many approaches have been recently developed to address the issue of standardization, none can yet be considered a standard method in the interpretation of PET/CT. We herein aim to validate a novel three-dimensional deep learning-based tool on PET/CT images for automated assessment of the intensity of BM metabolism in MM patients. Materials and methods Whole-body [18F]FDG PET/CT scans of 35 consecutive, previously untreated MM patients were studied. All patients were investigated in the context of an open-label, multicenter, randomized, active-controlled, phase 3 trial (GMMG-HD7). Qualitative (visual) analysis classified the PET/CT scans into three groups based on the presence and number of focal [18F]FDG-avid lesions as well as the degree of diffuse [18F]FDG uptake in the BM. The proposed automated method for BM metabolism assessment is based on an initial CT-based segmentation of the skeleton, its transfer to the SUV PET images, the subsequent application of different SUV thresholds, and refinement of the resulting regions using postprocessing. In the present analysis, six different SUV thresholds (Approaches 1–6) were applied for the definition of pathological tracer uptake in the skeleton [Approach 1: liver SUVmedian × 1.1 (axial skeleton), gluteal muscles SUVmedian × 4 (extremities). Approach 2: liver SUVmedian × 1.5 (axial skeleton), gluteal muscles SUVmedian × 4 (extremities). Approach 3: liver SUVmedian × 2 (axial skeleton), gluteal muscles SUVmedian × 4 (extremities). Approach 4: ≥ 2.5. Approach 5: ≥ 2.5 (axial skeleton), ≥ 2.0 (extremities). Approach 6: SUVmax liver]. Using the resulting masks, subsequent calculations of the whole-body metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in each patient were performed. A correlation analysis was performed between the automated PET values and the results of the visual PET/CT analysis as well as the histopathological, cytogenetical, and clinical data of the patients. Results BM segmentation and calculation of MTV and TLG after the application of the deep learning tool were feasible in all patients. A significant positive correlation (p < 0.05) was observed between the results of the visual analysis of the PET/CT scans for the three patient groups and the MTV and TLG values after the employment of all six [18F]FDG uptake thresholds. In addition, there were significant differences between the three patient groups with regard to their MTV and TLG values for all applied thresholds of pathological tracer uptake. Furthermore, we could demonstrate a significant, moderate, positive correlation of BM plasma cell infiltration and plasma levels of β2-microglobulin with the automated quantitative PET/CT parameters MTV and TLG after utilization of Approaches 1, 2, 4, and 5. Conclusions The automated, volumetric, whole-body PET/CT assessment of the BM metabolic activity in MM is feasible with the herein applied method and correlates with clinically relevant parameters in the disease. This methodology offers a potentially reliable tool in the direction of optimization and standardization of PET/CT interpretation in MM. Based on the present promising findings, the deep learning-based approach will be further evaluated in future prospective studies with larger patient cohorts.

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Italian Multicenter Study on Accuracy of 18 F-FDG PET/CT in Assessing Bone Marrow Involvement in Pediatric Hodgkin Lymphoma

Cistaro¹,

Cassalia²,

Ferrara

et al. 2018

Clinical Lymphoma Myeloma and Leukemia

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Evaluation of physiological FDG uptake in the skeleton in adults: Is it uniformly distributed?

Cited by 5 publications

References 14 publications

Physiological uptake of 18F-FDG in the vertebral bone marrow in healthy adults on PET/CT imaging

Physiological uptake of 18F-FDG in the vertebral bone marrow in healthy adults on PET/CT imaging

Application of an artificial intelligence-based tool in [18F]FDG PET/CT for the assessment of bone marrow involvement in multiple myeloma

Italian Multicenter Study on Accuracy of 18 F-FDG PET/CT in Assessing Bone Marrow Involvement in Pediatric Hodgkin Lymphoma

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