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

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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The Utility Of 18f-FDG PET/CT In Assessing Bone Marrow Involvement In Lymphoma

Blood ◽

10.1182/blood.v122.21.2981.2981 ◽

2013 ◽

Vol 122 (21) ◽

pp. 2981-2981 ◽

Cited By ~ 1

Author(s):

Chaitra S. Ujjani ◽

Elizabeth Hill ◽

Samer Nassif ◽

Hongkun Wang ◽

Yiru Wang ◽

...

Keyword(s):

Bone Marrow ◽

Ct Scan ◽

Bone Marrow Biopsy ◽

Fdg Pet ◽

Hodgkin’S Lymphoma ◽

Hodgkin's Lymphoma ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Pet Ct Scan

Abstract Background Determining bone marrow involvement (BMI) is a crucial element for staging of lymphoma. While the standard procedure to evaluate BMI has traditionally been bone marrow biopsy, biopsies are subject to sampling error, particularly if the involvement is focal and outside the pelvis. 18F-FDG PET/CT scans have become an increasingly popular component of the pretreatment evaluation to assess nodal and extramedullary disease. Their ability to accurately detect BMI has been suggested in Hodgkin's lymphoma, but is less well established in other histologies. This retrospective study evaluated whether 18F-FDG PET/CT scans are useful in detecting BMI in different types of lymphoma and, thus, may replace trephine biopsies as part of staging. Methods Between 2005 and 2013, 222 patients (pts) seen at our center underwent coinciding bone marrow biopsies and whole body 18F-FDG PET/CT scans. The most common lymphoma subtypes represented were diffuse large B-cell (DLBCL), follicular, and Hodgkin's lymphoma. Ninety-two pts were referred to our center for a new diagnosis and retrospectively enrolled on study. Unilateral bone marrow biopsy of the iliac crest was used as the standard for detecting BMI. 18F-FDG PET/CT scan was interpreted as positive for BMI when bone marrow 18F-FDG uptake was not otherwise explained by CT findings. Results Of the 92 newly diagnosed pts, there were 44 DLBCL, 28 follicular, and 20 Hodgkin's lymphoma. Most pts underwent 18F-FDG PET/CT scan prior to biopsy (47), as opposed to the same day (13) or after (32). The median age at diagnosis was 48 years (Range 22-89). Fifty-one of the patients were male and 41 were female. Seven of the 44 DLBCL patients had BMI documented by biopsy; 5 DLBCL, 2 follicular. When evaluating for only DLBCL marrow involvement, the sensitivity, specificity, and accuracy (concordance) of 18F-FDG PET/CT scan was 80% (CI 0.28, 0.99), 97% (CI 0.86, 1.00), and 95% (CI 0.84, 0.99) respectively. 18F-FDG PET/CT scan failed to identify 1 patient with focal DLBCL involvement. This pt already had advanced stage disease based on imaging, and would have received the same treatment regimen regardless of the extra information provided by bone marrow biopsy. When accounting for any kind of lymphomatous involvement, the sensitivity dropped to 57% (CI 0.18, 0.90) as 18F-FDG PET/CT scan failed to identify the 2 pts with follicular lymphoma of the marrow. Specificity and accuracy, however, remained high at 97% and 91%. When evaluating pts with relapsed disease, all DLBCL pts in our cohort had negative BMI by both biopsy and 18F-FDG PET/CT. In follicular lymphoma, however, the sensitivity of 18F-FDG PET/CT was 43% (CI 0.21, 0.73), specificity 93% (CI 0.64, 1.00), and accuracy 68% (CI 0.48, 0.84). Of the 9 pts with discordant results, 18F-FDG PET/CT failed to identify 8 pts with marrow involvement, 6 of whom had focal involvement. In the remaining pt, 18F-FDG PET/CT scan indicated appendicular skeletal and vertebral involvement. The bone marrow biopsy was negative in this pt, presumably due to the lack of iliac involvement. Information provided by bone marrow biopsy upstaged one of the 9 pts from limited to advanced stage disease. In the 12 pts with relapsed disease, the sensitivity was 47%, specificity 93%, and accuracy 68% based on 22 coinciding studies. In Hodgkin's lymphoma, the sensitivity, specificity, and accuracy of 18F-FDG PET/CT at diagnosis was 67% (CI 0.09, 0.99), 71% (CI 0.44, 0.90), and 70% (CI 0.46, 0.88) respectively. Of the 5 Hodgkin's pts with discordant results, 18F-FDG PET/CT scans detected marrow involvement in 4 pts with negative bone marrow biopsies. One pt had evidence of marrow involvement by biopsy but not by 18F-FDG PET/CT. As the pt was already stage III by 18F-FDG PET/CT, this information did not impact the treatment regimen. Conclusions In our cohort, 18F-FDG PET/CT was a highly accurate tool for detecting BMI in DLBCL and Hodgkin's lymphoma. As most pts underwent imaging first, the subsequent biopsy was unnecessary. In Hodgkin's, 18F-FDG PET/CT demonstrated the ability to detect BMI in pts who would have otherwise been considered to be negative by biopsy alone. 18F-FDG PET/CT was not as accurate in follicular lymphoma, presumably due to the low-grade nature of the disease. Further evaluation in a prospective manner is warranted, and may eliminate the need for a costly and painful procedure in many pts with lymphoma. Disclosures: No relevant conflicts of interest to declare.

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Unusual presentation of sarcoid-like reaction on bone marrow level associated with mediastinal lymphadenopathy on 18F-FDG-PET/CT resembling an early recurrence of Hodgkin's Lymphoma

Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) ◽

10.1016/j.remnie.2012.07.007 ◽

2012 ◽

Vol 31 (4) ◽

pp. 207-209

Author(s):

F. Fallanca ◽

M. Picchio ◽

C. Crivellaro ◽

P. Mapelli ◽

A.M. Samanes Gajate ◽

...

Keyword(s):

Bone Marrow ◽

Fdg Pet ◽

Hodgkin’S Lymphoma ◽

Early Recurrence ◽

Unusual Presentation ◽

Hodgkin's Lymphoma ◽

Mediastinal Lymphadenopathy ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Occipital Hypometabolism on FDG PET/CT Scan in a Child with Hodgkin’s Lymphoma

Case Reports in Radiology ◽

10.1155/2016/5476108 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Inci Uslu Biner ◽

Ebru Tatci ◽

Ozlem Ozmen ◽

Atila Gokcek ◽

Haci Ahmet Demir ◽

...

Keyword(s):

Ct Scan ◽

Fdg Pet ◽

Hodgkin’S Lymphoma ◽

Perinatal Asphyxia ◽

Hodgkin's Lymphoma ◽

Emission Computed Tomography ◽

Brain Disorder ◽

Pet Ct ◽

Fdg Pet Ct ◽

Pet Ct Scan

It is known that Fluorodeoxyglucose (FDG) Positron Emission/Computed Tomography (PET/CT) images may be helpful for evaluation of brain function in newborns. Here we described the fluorine-18 [18-F] FDG PET/CT imaging findings of encephalomalacia due to perinatal asphyxia in a child with refractory Hodgkin’s Lymphoma (HL) who underwent PET/CT scan to stage the primary disease. Prominent hypometabolism was incidentally detected in the occipital regions bilaterally apart from the FDG uptakes in the malign lymphatic infiltrations. This case highlights the potential coexistence of a malignancy and a functional brain disorder.

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Disseminated focal 18F-fluoro-deoxyglucose uptake upon granulocyte colony-stimulating factor therapy mimicking malignant bone infiltration: case report of a patient with very severe aplastic anemia

Therapeutic Advances in Hematology ◽

10.1177/2040620720977613 ◽

2020 ◽

Vol 11 ◽

pp. 204062072097761

Author(s):

Lena Horvath ◽

Andreas Seeber ◽

Christian Uprimny ◽

Dominik Wolf ◽

David Nachbaur ◽

...

Keyword(s):

Bone Marrow ◽

Ct Scan ◽

Aplastic Anemia ◽

Fdg Pet ◽

Mediastinal Mass ◽

Pet Ct ◽

Bone Infiltration ◽

18F Fdg ◽

Fdg Pet Ct ◽

Pet Ct Scan

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.

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