Abstract:The aim of the present study was to investigate the value of systemic [F]fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) in the diagnosis and differential diagnosis of aplastic anemia (AA). Systemic PET/CT imaging results of 24 patients diagnosed with AA in The First Affiliated Hospital of Sun Yat-Sen University between May 2011 and August 2014 were retrospectively analyzed and compared with results from healthy individuals and patients with acute leukemia (AL) or myelodysplastic… Show more
“… 14 Positron emission tomography/computed tomography (PET/CT) examination has shown low bone metabolism in AA patients, which could be used for differential diagnosis from atypical MDS. 27 However, PET/CT is expensive and requires injections of radioactive agents. Quantitative analysis of bone marrow fat (BMF) content through IDEAL‐IQ imaging allows for the detection of abnormal changes in the bone marrow.…”
Background: Bone marrow of patients with aplastic anemia (AA) is different from that of patients with myelodysplastic syndrome (MDS) and is difficult to identify by blood examination. IDEAL-IQ (iterative decomposition of water and fat with echo asymmetry and least-squares estimation) imaging might be able to quantify fat fraction (FF) and iron content in bone tissues. Purpose: To determine if IDEAL-IQ measurements of bone marrow FF and iron content can distinguish between patients with AA and MDS. Study Type: Retrospective. Population: Fifty-seven patients with AA, 21 patients with MDS, and 24 healthy controls. Field Strength/Sequence: 3.0 T, IDEAL-IQ sequence. Assessment: Three independent observers evaluated the IDEAL-IQ images and measured FF and R2* in the left posterior superior iliac spine. Statistical Tests: Kruskal-Wallis test, linear correlations, and Bland-Altman analysis were used. A P-value of <0.05 was considered statistically significant. Results: The FF in patients with AA (79.46% AE 15.00%) was significantly higher than that in patients with MDS (42.78% AE 30.09%) and control subjects (65.50% AE 14.73%). However, there was no significant difference in FF between control subjects and patients with MDS (P = 0.439).
“… 14 Positron emission tomography/computed tomography (PET/CT) examination has shown low bone metabolism in AA patients, which could be used for differential diagnosis from atypical MDS. 27 However, PET/CT is expensive and requires injections of radioactive agents. Quantitative analysis of bone marrow fat (BMF) content through IDEAL‐IQ imaging allows for the detection of abnormal changes in the bone marrow.…”
Background: Bone marrow of patients with aplastic anemia (AA) is different from that of patients with myelodysplastic syndrome (MDS) and is difficult to identify by blood examination. IDEAL-IQ (iterative decomposition of water and fat with echo asymmetry and least-squares estimation) imaging might be able to quantify fat fraction (FF) and iron content in bone tissues. Purpose: To determine if IDEAL-IQ measurements of bone marrow FF and iron content can distinguish between patients with AA and MDS. Study Type: Retrospective. Population: Fifty-seven patients with AA, 21 patients with MDS, and 24 healthy controls. Field Strength/Sequence: 3.0 T, IDEAL-IQ sequence. Assessment: Three independent observers evaluated the IDEAL-IQ images and measured FF and R2* in the left posterior superior iliac spine. Statistical Tests: Kruskal-Wallis test, linear correlations, and Bland-Altman analysis were used. A P-value of <0.05 was considered statistically significant. Results: The FF in patients with AA (79.46% AE 15.00%) was significantly higher than that in patients with MDS (42.78% AE 30.09%) and control subjects (65.50% AE 14.73%). However, there was no significant difference in FF between control subjects and patients with MDS (P = 0.439).
“…16 In patients with aplastic anemia, a recent study described three different types of [18F]FDG-PET manifestations, including normal BM metabolism, generalized hypometabolism, and diffuse hypometabolism associated with focal hyperproliferation. 17 As for the latter, the inhomogeneous BM metabolism and patchy distribution of [18F] FDG uptake (also described elsewhere in case reports [18][19][20] ) most frequently occurs in the vertebral bodies, sternum and iliac bones. 17 The spots probably indicate residual compensatory hyperplastic hematopoietic islands in an otherwise aplastic BM 17,20 and are associated with an active phase of the disease.…”
Section: Discussionmentioning
confidence: 80%
“…17 As for the latter, the inhomogeneous BM metabolism and patchy distribution of [18F] FDG uptake (also described elsewhere in case reports [18][19][20] ) most frequently occurs in the vertebral bodies, sternum and iliac bones. 17 The spots probably indicate residual compensatory hyperplastic hematopoietic islands in an otherwise aplastic BM 17,20 and are associated with an active phase of the disease. The patchy [18F]FDG distribution seems to persist even in patients in remission after immunosuppressive therapy.…”
Combined 18F-fluoro-deoxyglucose ([18F]FDG) positron emission tomography and computed tomography ([18F]FDG-PET/CT) is increasingly used for the diagnostic and therapeutic management of hematologic and non-hematologic malignancies. Here, we describe a unique case of a patient presenting with very severe aplastic anemia and a mediastinal mass showing disseminated hypermetabolic lesions of the bones after receiving granulocyte colony-stimulating factor (G-CSF), highly suspicious for disseminated metastatic lesions. A 71-year-old patient presented with a 3 week history of dyspnea and fatigue. Blood tests showed severe pancytopenia and iliac crest bone marrow biopsy revealed an extensively hypoplastic bone marrow. Diagnostic work-up by histology, conventional cytogenetics and flow cytometry confirmed the diagnosis of very severe aplastic anemia. Besides blood transfusions, the patient was treated with G-CSF. Furthermore, computed tomography revealed a suspect mass in the anterior mediastinum, presenting with moderate glucose metabolism in the subsequent [18F]FDG-PET/CT scan. In addition, multiple disseminated and highly metabolic bone lesions of primarily the ribs were detected, suspicious of malignant bone infiltration. Since physiologic bone marrow activation by G-CSF-stimulation could not be ruled out, G-CSF therapy was interrupted to repeat the PET/CT scan 10 days later. On the second [18F]FDG-PET/CT the moderately hypermetabolic mediastinal mass persisted. However, the initially FDG-avid bone lesions almost completely resolved, rendering the diagnosis of G-CSF-induced bone marrow hypermetabolism very likely without the need for further invasive diagnostic procedures. The mediastinal mass was thereafter histologically verified as thymoma. Interpretation of [18F]FDG-PET/CT in patients with aplastic anemia may be complicated by the frequent therapeutic use of G-CSF. With G-CSF, islets of residual bone marrow activity can be visualized on [18F]FDG-PET/CT images that might be misinterpreted as malignant bone infiltration. Repeating PET/CT scan after G-CSF discontinuation can prevent unnecessary invasive diagnostic procedures in these patients.
“…Diffuse 18F-FDG uptake significantly increased in the bone marrow, liver and spleen. The SUVmax values in the bone marrow, liver, and spleen were 6.6, 5.3, and 4.6, respectively, and these values were higher than those measured in healthy people who underwent whole-body 18F-FDG-PET/CT examination at our hospital [ 8 ] ( Figure 5 ). Figure 5.…”
Megaloblastic anemia (MA) patients often exhibit hemolysis, but it is not clear whether there are other hemolytic mechanisms in addition to intramedullary hemolysis. We retrospectively analyzed the clinical characteristics of 124 MA patients, measured erythrocyte physical parameters in two patients with hemolysis and one healthy volunteer by atomic force microscopy, and measured 18F-FDG uptake in one MA patient with hemolysis. In multivariate analysis, hemolysis was associated with mean corpuscular volume (MCV) and indirect bilirubin. A receiver operating characteristic curve analysis, with sensitivity of 83.1% and specificity of 68.7%, suggested that the MCV cutoff value that predicts hemolysis is 116.4 fL. Hb was negatively correlated with MCV in the hemolysis group (r = −0.317, P = 0.007) but not in the nonhemolysis group. The erythrocyte peak-valley value, average cell surface roughness and surface area in the MA patients with hemolysis were significantly lower than those in controls (P < 0.05). 18F-FDG uptake by the liver and spleen was diffuse and increased in MA patients undergoing hemolysis. MA combined with extramedullary hemolysis could be caused by macrophages removing mechanically damaged erythrocytes and the retention of erythrocytes with decreased deformability when blood circulates through narrow spaces in the liver and spleen.
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