[¹⁸F]Fluorodeoxyglucose Positron Emission Tomography for Detection of Bone Marrow Involvement in Children and Adolescents With Hodgkin's Lymphoma

Abstract

FDG-PET is a sensitive and specific method for the detection of BM involvement in pediatric HL. The sensitivity of a BMB appears compromised by the focal pattern of BM involvement. Thus, FDG-PET may safely be substituted for a BMB in routine staging procedures.

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

“…Our findings are also supported -even though not absolutely concordant -by a recent publication by Hong et al [13]. Purz et al assumed in their study that all focal lesions represented bone marrow involvement by segmented BM involvement [14], even Coronal PET and fused images and sagittal fused images in a 28 year old male shows intense and patchy uptake in the axial and appendicular skeleton. Biopsy was positive for bone marrow involvement with Lymphoma.…”

“…Several studies have claimed the benefit of being able to predict bone marrow pathology with FDG PET [6,7,14,[17][18][19][20], however their methodologies differ, their analysis does not always use a BM b as a gold standard, or ignores the results of the BM b and we could not reproduce their conclusions. On the other hand other authors have proposed that qualitative or semi-quantitative BM uptake on […”

“…However this is not uncommon in the reported literature in the presence of anatomical skeletal lesions on CT or MRI when the focality was likely to be due to cortical bone metastasis and not bone marrow infiltration/implants. A large number of patients were assumed to be BM positive by indirect evidence of focality and diffuse uptake was assumed to be reactive and while it is frequently the case, bone marrow infiltration will also appear similarly as diffuse uptake and discrimination is very difficult [14]. In our study 6 patients with diffuse uptake had a positive BM b .…”

“…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.…”

Targeted PET imaging strategy to differentiate malignant from inflamed lymph nodes in diffuse large B-cell lymphoma

“…The [ 18 F]FDG tracer has been shown to be a reliable diagnostic tool for detection of DLBCL (6,9), identification of bone marrow metastasis (10,11), and monitoring of therapy (12). However, the reliability of [ 18 F]FDG-PET can be affected by uptake of the tracer by nonmalignant tissues that also consume high levels of glucose.…”