Whole body FDG-PET/CT for the assessment of bone marrow infiltration in patients with newly diagnosed lymphoma

Abstract Background: Routine bone marrow biopsy (BMB) for the initial staging of Hodgkin Lymphoma (HL) is not recommended in the era of FDG-PET/CT staging (J Clin Oncol. 2014;32(27):3059). However, patients from the Middle East and North Africa (MENA) region have epidemiologic and clinical features of lymphoma that are different from patients of other ethnicities (J Natl Compr Canc Net2010;8:S-29-S-35). Therefore, it is unknown whetherFDG-PET/CT can substitute for staging BMB in this population.At our center, we perform routine BMB for all newly diagnosed lymphoma cases. Aim: To investigate whether routine BMB is essential in detecting bone marrow disease where FDG-PET/CT is used in initial staging for HL in patients from the MENA region. Methods: Patients with HL at our institution between 2010 - 2015 were identified. Inclusion criteria included newly diagnosed patients who had BMB and FDG-PET/CT as part of initial staging. All baseline and laboratory features were retrospectively extracted. Pathology reports of bone marrow aspirate and trephine biopsies were reviewed by two independent Hematologists. All written FDG-PET/CT reports were retrieved and carefully reviewed and cases with positive skeletal uptake were re-interpreted by an experienced radiologist. Pattern of skeletal FDG-PET/CT uptake was determined and classified as unifocal or multifocal. Sensitivity and specificity was computed while defining bone marrow disease by positive BMB and / or focal skeletal uptake on FDG-PET/CT. Categorical and continuous variables were analyzed using Pearson's chi-squared and Student's t-test, respectively. Results: A. Baseline characteristics: A total of92 patients met the inclusion criteria and were considered for this analysis. All patients were from the MENA region and > 90% were from the Arabian peninsula. From this cohort, bone marrow disease was detected in 7 (7.6%) patients using BMB while 20 (21.7%) patients had unifocal or multifocal bone marrow uptake on FDG-PET/CT. An additional 21 patients (23%) had diffuse homogenous FDG uptake and was not considered to represent HL. The cohort was characterized by a male to female ratio of 1.4 and a median age at diagnosis of 27 years (6-83). About two thirds of the cases were classical HL of the nodular sclerosis subtype (Table 1). Almost 60% of cases were stage III - IV with corresponding median IPS of 2 (0-6). Incidence of bulky disease and B-symptoms among the entire cohort was 32% and 50%, respectively. B. Comparison of FDG-PET/CT and BMB No patient with involved BMB (iBMB) had early stage disease on FDG-PET/CT and BMB identified only one patient with positive BM involvement yet negative skeletal uptake on FED-PET/CT. Involvement by BMB upstaged 3 patients previously assessed by CT scan as having stage III, however, none of the patients were allocated to a different treatment plan based on the BMB result. On the other hand, FDG-PET/CT upstaged 24 patients (26%); 9 patients from stage III to IV and 14 patients from early to advanced stage resulting in change of therapeutic plan in the latter group. Focal skeletal FDG-PET/CT lesions identified positive marrow disease with a sensitivity and specificity of 95.2% and 70.4%, respectively. On the other hand, sensitivity and specificity of BMB was 35% and 100%, respectively (Table 2). Abnormal skeletal FDG uptake was seen in a total of 20 patients (21.7%); 11 (55%) had unifocal / bifocal while 9 (45%) had multifocal disease of the axial skeleton. Patients with iBMB compared to those with negative BMB but positive unifocal / multifocal skeletal FDG-PET/CT lesions were more likely to be male (p = 0.002), have B-symptoms (p = 0.028), extranodal disease (p = 0.017) and more likely to have multifocal uptake on FDG-PET/CT (0.017) (Table 3). Conclusion:To our knowledge, this is the first analysis to examine the role of FDG-PET/CT for detection of bone marrow involvement in HL in a patient cohort from the MENA region. We observed that FDG-PET/CT had a higher sensitivity and negative predictive value compared to BMB leading to a treatment change in a significant proportion of patients. This analysis highlightsthat FDG-PET/CT can substitute for BMB in routine staging for newly diagnosed patients with HL from the MENA region. Disclosures No relevant conflicts of interest to declare.

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The Role of Whole-Body FDG PET/CT, Tc 99m MDP Bone Scintigraphy, and Serum Alkaline Phosphatase in Detecting Bone Metastasis in Patients with Newly Diagnosed Lung Cancer

Journal of Korean Medical Science ◽

10.3346/jkms.2009.24.2.275 ◽

2009 ◽

Vol 24 (2) ◽

pp. 275 ◽

Cited By ~ 41

Author(s):

Joo-Won Min ◽

Sang-Won Um ◽

Jae-Jun Yim ◽

Chul-Gyu Yoo ◽

Sung Koo Han ◽

...

Keyword(s):

Lung Cancer ◽

Alkaline Phosphatase ◽

Bone Metastasis ◽

Fdg Pet ◽

Serum Alkaline Phosphatase ◽

Whole Body ◽

Newly Diagnosed ◽

Pet Ct ◽

Fdg Pet Ct

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Role of Whole-Body 18F-FDG PET/CT in Screening for Metastases in Newly Diagnosed Sinonasal Malignancies

American Journal of Roentgenology ◽

10.2214/ajr.18.20311 ◽

2019 ◽

Vol 212 (6) ◽

pp. 1327-1334

Author(s):

Kerem Ozturk ◽

Mehmet Gencturk ◽

Matthew Rischall ◽

Emiro Caicedo-Granados ◽

Faqian Li ◽

...

Keyword(s):

Fdg Pet ◽

Whole Body ◽

Newly Diagnosed ◽

Sinonasal Malignancies ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Assessment of the role of 18F-FDG PET CT in detection of bone marrow infiltration in comparison to the Bone Marrow Aspirate in Lymphoma patients

QJM ◽

10.1093/qjmed/hcab106.031 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Madonna Adel Mikhail Ghaly ◽

Aida Mohamed El Shibiny ◽

Susan Adil Ali Abdul Rahim

Keyword(s):

Bone Marrow ◽

Ct Scan ◽

Fdg Pet ◽

Hodgkin’S Lymphoma ◽

Hodgkin's Lymphoma ◽

Bone Marrow Infiltration ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Pet Ct Scan

Abstract Background 18-F-2-Deoxy-D-Glucose Positron Emission Tomography [FDG-PET], combined with multidetector helical Computed Tomography [PET/CT] has emerged as a one of the most important prognostic tools for lymphoma management. Previous studies have indicated that PET/CT is a convenient method for bone marrow assessment in patients with lymphoma. A blind Bone Marrow Biopsy [BMB] has been traditionally used as the golden standard in marrow evaluation despite its invasiveness. Objective is to compare the results of PET/CT with BMB regarding bone marrow infiltration [BMI] in patients with Hodgkin's Lymphoma [HL] and Non-Hodgkin's Lymphoma [NHL] and to characterize the visual bone marrow FDG uptake pattern by PET-CT Methods A cross sectional study including 27 cases of Lymphoma, conducted at Ain Shams University hospitals, the patients were investigated using PET-CT scan and BMB ,the period was between December 2018 till the end of May 2019. Results Our study included 27 histologically proved Lymphoma patients, 14 (51.9%) were males and 13 (48.1%) were females, with age ranging from 17 to 69 years (mean 45 years). Among the total cases, 17 (63%) patients had NHL, while 10 (37%) patients had HL. All the patients were evaluated at first by BMB (taken from the dorsal portion of the iliac crest) for initial staging, then the patients underwent PET/CT scan. The study revealed 12 patients (44.4%) had BMI detected by PET/CT imaging; however, only 7 patients (25.9%) were detected by BMB. BMB and 18F-FDG PET/CT scans were concordant for BMI detection in 22 patients (81.5%): positive concordance in 7 patients and negative in 15. Of the 5 discordant cases, four had a focal marrow intense FDG uptake detected by PET/CT and were upstaged as their BMB results were false-negative, one patient had intense diffuse marrow uptake by PET/CT while its BMB was negative (revealed only hyper cellularity with mild dysplasia). The sensitivity, specificity, PPV, and NPV of PET for identifying BMI was 100%, 75%, 58.3%, 100% respectively with a diagnostic accuracy 81.5% with a (p value < 0.05). Conclusion 18F-FDG PET-CT imaging is more sensitive than bone marrow biopsy for bone marrow infiltration detection in Hodgkin's Lymphoma and Non-Hodgkin's Lymphoma staging.

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18F-FDG PET, combined FDG-PET/CT and MRI for evaluation of bone marrow infiltration in staging of lymphoma: A systematic review and meta-analysis

European Journal of Radiology ◽

10.1016/j.ejrad.2010.11.020 ◽

2012 ◽

Vol 81 (2) ◽

pp. 303-311 ◽

Cited By ~ 35

Author(s):

Lian-Ming Wu ◽

Fang-Yuan Chen ◽

Xiao-Xing Jiang ◽

Hai-Yan Gu ◽

Yan Yin ◽

...

Keyword(s):

Systematic Review ◽

Bone Marrow ◽

Fdg Pet ◽

Meta Analysis ◽

Bone Marrow Infiltration ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Ct And Mri

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PD1-2-2: The role of whole-body FDG PET/CT, Tc 99m mdp bone scintigraphy, and serum alkaline phosphatase in detecting bone metastasis in patients with newly diagnosed lung cancer

Journal of Thoracic Oncology ◽

10.1097/01.jto.0000283308.25314.ed ◽

2007 ◽

Vol 2 (8) ◽

pp. S417

Author(s):

Joo-Won Min ◽

Sang-Won Um ◽

Jae-Jun Yim ◽

Chul-Gyu Yoo ◽

Sung Koo Han ◽

...

Keyword(s):

Lung Cancer ◽

Alkaline Phosphatase ◽

Bone Metastasis ◽

Fdg Pet ◽

Serum Alkaline Phosphatase ◽

Whole Body ◽

Newly Diagnosed ◽

Pet Ct ◽

Fdg Pet Ct

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Myocardial Glucose Metabolism Is Increased in Newly Diagnosed Lung Adenocarcinoma

Cardiology ◽

10.1159/000515473 ◽

2021 ◽

pp. 1-9

Author(s):

Jiaoyan Wu ◽

Li Wang ◽

Yuetao Wang ◽

Min-Fu Yang

Keyword(s):

Bone Marrow ◽

Glucose Metabolism ◽

Lung Adenocarcinoma ◽

Fdg Pet ◽

Arterial Wall ◽

Left Ventricular ◽

Newly Diagnosed ◽

Myocardial Glucose Metabolism ◽

Pet Ct ◽

Fdg Pet Ct

Background: Cardiac metabolism alterations may be involved in abnormalities of cancer patients’ cardiovascular system. This study aimed to explore whether left ventricular myocardial glucose metabolism is altered and its related factors in newly diagnosed patients with lung adenocarcinoma (LAD) who underwent fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). Methods: From our 18F-FDG PET/CT imaging database, 171 patients with newly diagnosed LAD and 43 nononcologic subjects with matched age and sex were retrospectively analyzed. The included patients underwent conventional 18F-FDG PET/CT imaging with a >12-h fasting before 18F-FDG administration. The standardized uptake values (SUVs) of the left ventricular (LV) myocardium, arterial wall, epicardial adipose tissue (EAT), spleen, and bone marrow were separately measured. Laboratory parameters and echocardiographic results were collected as well. LAD patients were divided into 2 groups based on the 95th percentile of LV maximal SUV (SUVmax) obtained from the 43 nononcologic subjects. Univariate analysis and multiple logistic regression analysis were used to identify significant factors. Results: Higher LV SUVmax was found (3.8 [2.4, 7.7] vs. 3.0 [2.0, 5.4], p = 0.052) in LAD than that in nononcologic patients, whereas no significant differences of 18F-FDG uptake were found in the arterial wall, EAT, spleen, or bone marrow between LAD patients and controls. The maximum diameter (Dmax) of the LAD lesion, SUVmax of spleen, and SUVmax of EAT were related to LV SUVmax in LAD. Conclusions: Myocardial glucose metabolism is increased in patients with newly diagnosed LAD. Dmax of LAD lesion, spleen activity, and EAT activity contribute to the increased LV activity in LAD.

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A First Report on [18F]FPRGD2 PET/CT Imaging in Multiple Myeloma

Contrast Media & Molecular Imaging ◽

10.1155/2017/6162845 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7

Author(s):

Nadia Withofs ◽

François Cousin ◽

Bernard De Prijck ◽

Christophe Bonnet ◽

Roland Hustinx ◽

...

Keyword(s):

Multiple Myeloma ◽

Fdg Pet ◽

Low Dose ◽

Bone Lesion ◽

Bone Destruction ◽

Whole Body ◽

Newly Diagnosed ◽

Low Dose Ct ◽

Pet Ct ◽

Fdg Pet Ct

An observational study was set up to assess the feasibility of [F18]FPRGD2 PET/CT for imaging patients with multiple myeloma (MM) and to compare its detection rate with low dose CT alone and combined [F18]NaF/[F18]FDG PET/CT images. Four patients (2 newly diagnosed patients and 2 with relapsed MM) were included and underwent whole-body PET/CT after injection of [F18]FPRGD2. The obtained images were compared with results of low dose CT and already available results of a combined [F18]NaF/[F18]FDG PET/CT. In total, 81 focal lesions (FLs) were detected with PET/CT and an underlying bone destruction or fracture was seen in 72 (89%) or 8 (10%) FLs, respectively. Fewer FLs (54%) were detected by [F18]FPRGD2 PET/CT compared to low dose CT (98%) or [F18]NaF/[F18]FDG PET/CT (70%) and all FLs detected with [F18]FPRGD2 PET were associated with an underlying bone lesion. In one newly diagnosed patient, more [F18]FPRGD2 positive lesions were seen than [F18]NaF/[F18]FDG positive lesions. This study suggests that [F18]FPRGD2 PET/CT might be less useful for the detection of myeloma lesions in patients with advanced disease as all FLs with [F18]FPRGD2 uptake were already detected with CT alone.

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