scholarly journals 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

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.

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 ◽  
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.

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

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2981-2981 ◽  
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.

Total-body 18F-FDG PET/CT scan in oncology patients: how fast could it be?

2021 ◽  
Author(s):  
Pengcheng Hu ◽  
Yiqiu Zhang ◽  
Haojun Yu ◽  
Shuguang Chen ◽  
Hui Tan ◽  
...  
Keyword(s):  
Ct Scan ◽  
Fdg Pet ◽  
Oncology Patients ◽  
Pet Ct ◽  
18F Fdg ◽  
Total Body ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

scholarly journals Dual-tracer (68Ga-DOTATOC and 18F-FDG-)-PET/CT scan and G1-G2 non-functioning pancreatic neuroendocrine tumors: A single-center retrospective evaluation of 124 non-metastatic resected cases

2021 ◽  
Author(s):  
Salvatore Paiella ◽  
Luca Landoni ◽  
Sarah Tebaldi ◽  
Michele Zuffante ◽  
Matteo Salgarello ◽  
...  
Keyword(s):  
Ct Scan ◽  
Neuroendocrine Tumors ◽  
Fdg Pet ◽  
Pancreatic Neuroendocrine Tumors ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Work Up ◽  
Pet Ct Scan ◽  
Dual Tracer

Introduction:The combined use of 68Gallium [68GA]-DOTA-peptides and 18Fluorine-fluoro-2-deoxyglucose [18F-FDG] PET/TC scans in the work-up of pancreatic neuroendocrine tumors (PanNETs) is controversial. This study aimed at assessing both tracers’ capability to identify tumors and to assess its association with pathological predictors of recurrence. Methods:Prospectively collected, preoperative, dual-tracer PET/CT scan data of G1-G2, non-metastatic, PanNETs that underwent surgery between January 2013 and October 2019 were retrospectively analyzed. Results:The final cohort consisted of 124 cases. There was an approximately equal distribution of males and females(50.8%/49.2%), and G1 and G2 tumors(49.2%/50.8%). The disease was detected in 122(98.4%) and 64(51.6%) cases by 68Ga-DOTATOC and by 18F-FDG PET/CT scans, respectively, with a combined sensitivity of 99.2%. 18F-FDG-positive examinations found G2 tumors more often than G1 (59.4% versus 40.6%;p = 0.036), and 18F-FDG-positive PanNETs were larger than negative ones (median tumor size 32 mm, IQR 21 versus 26 mm, IQR 20;p = 0.019). The median Ki67 for 18F-FDG-positive and -negative examinations was 3(IQR 4) and 2(IQR 4), respectively, (p = 0.029). At least one pathologic predictor of recurrence was present in 74.6% of 18F-FDG-positive cases (versus 56.7%;p = 0.039), whereas this was not found when dichotomizing the PanNETs by their dimensions (≤/> 20 mm). None of the two tracers predicted nodal metastasis. ROC curve analysis showed that 18F-FDG uptake higher than 4.2 had a sensitivity of 49.2%, and specificity of 73.3% for differentiating G1 from G2 (AUC=0.624, p=0.009). Conclusion: The complementary adoption of 68Ga-DOTATOC and 18F-FDG tracers may be valuable in the diagnostic work-up of PanNETs despite not being a game-changer for the management of PanNETs ≤ 20 mm.

scholarly journals Quantitative 18F-FDG PET-CT scan characteristics correlate with tuberculosis treatment response

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Stephanus T. Malherbe ◽  
Ray Y. Chen ◽  
Patrick Dupont ◽  
Ilse Kant ◽  
Magdalena Kriel ◽  
...  
Keyword(s):  
Ct Scan ◽  
Treatment Response ◽  
Fdg Pet ◽  
Tuberculosis Treatment ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

Mo1406 Functional Role of 18F-FDG PET/CT Scan in Diabetic Patients With Pancreatic Ductal Adenocarcinomas

2013 ◽  
Vol 144 (5) ◽  
pp. S-658
Author(s):  
Kwang Hyun Chung ◽  
Yoon Suk Lee ◽  
Joo Kyung Park ◽  
Sang Hyub Lee ◽  
Jin-Hyeok Hwang
Keyword(s):  
Ct Scan ◽  
Fdg Pet ◽  
Functional Role ◽  
Diabetic Patients ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

Lipomatous Hypertrophy of the Interatrial Septum. Findings in the 18F-FDG PET/CT Scan; MRI

2011 ◽  
Vol 30 (6) ◽  
pp. 382-383
Author(s):  
J.R. García ◽  
I. Vollmer ◽  
M. Soler ◽  
F.J. Álvarez-Moro ◽  
S. Fuertes ◽  
...  
Keyword(s):  
Ct Scan ◽  
Fdg Pet ◽  
Interatrial Septum ◽  
Pet Ct ◽  
Lipomatous Hypertrophy ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

scholarly journals Curious case of fever of unknown origin

2018 ◽  
Vol 11 (1) ◽  
pp. bcr-2018-227258
Author(s):  
Manasvini Bhatt ◽  
Manish Soneja ◽  
Madhavi Tripathi ◽  
Ashutosh Biswas
Keyword(s):  
Ct Scan ◽  
Fdg Pet ◽  
Unknown Origin ◽  
Bone Marrow Examination ◽  
Contrast Enhanced Ct ◽  
Positron Emission ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

A 58-year-old immunocompetent woman presented with fever and significant weight loss of 4-month duration. She had mild pallor; rest of the examination was unremarkable. Investigations revealed anaemia with raised inflammatory markers. Cultures, serologies, routine urine examination, bone marrow examination, contrast enhanced CT and two-dimensional echocardiography examination were unremarkable. An 18F-fluorodeoxyglucose positron emission tomography with CT (18F-FDG-PET/CT) scan was performed which revealed atypical heterogenous uptake in bilateral renal cortex. Subsequently, urine GeneXpert came positive for Mycobacterium tuberculosis with sensitivity to rifampicin. She responded to category 1 antitubercular therapy. The challenges in diagnosis of genitourinary tuberculosis, low sensitivity of conventional diagnostic tests and potential role of GeneXpert and 18F-FDG-PET/CT scan are discussed in this report.

scholarly journals Prevalence of Newly Diagnosed Malignancies in Patients with Polymyalgia Rheumatica and Giant Cell Arteritis, Comparison of 18F-FDG PET/CT Scan with Chest X-ray and Abdominal Ultrasound: Data from a 40 Week Prospective, Exploratory, Single Centre Study

2020 ◽  
Vol 9 (12) ◽  
pp. 3940
Author(s):  
Amir Emamifar ◽  
Søren Hess ◽  
Torkell Ellingsen ◽  
Susan Due Kay ◽  
Jacob Christian Bang ◽  
...  
Keyword(s):  
Ct Scan ◽  
Fdg Pet ◽  
Abdominal Ultrasound ◽  
Newly Diagnosed ◽  
X Ray ◽  
Pet Ct ◽  
Chest X Ray ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

The aim of the study was to identify the prevalence of newly diagnosed malignancies in patients with polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), with the aid of 18F-FDG PET/CT scan compared to conventional imaging techniques: Chest X-ray (CXR) and abdominal ultrasound (US). Secondarily, to examine the relative diagnostic accuracy of these two imaging modalities for the detection of cancer. Eighty consecutive patients with newly diagnosed PMR, GCA, or concomitant PMR and GCA, were included and followed up for 40 weeks. All patients underwent an 18F-FDG PET/CT scan, CXR, and abdominal US at diagnosis. Imaging findings were dichotomously categorized into malignant or benign. Among 80 patients, three patients were diagnosed with seronegative rheumatoid arthritis and were excluded from the analysis. Of the remaining 77, 64 (83.1%) patients were diagnosed with pure PMR, 3 (3.9%) with pure GCA, and 10 (13.0%) with concomitant PMR and GCA. Five types of cancer that were more prevalent than the one-year prevalence of 1.2% among the background population were found in four (5.2%; 95%CI: 1.4–12.8%) patients. CXR/abdominal US could detect the solid cancer in one patient, whereas 18F-FDG PET/CT could identify all four solid cancers. Furthermore, four (5.2%; 95%CI: 1.4–12.8%) cases of monoclonal gammopathy of undetermined significance (MGUS) were found. An increase in C reactive protein (CRP) implicated an increased risk for cancer of 2.4% (OR: 1.024, 95%CI: 1.001–1.047; p = 0.041). 18F-FDG PET/CT can reveal occult cancers at an early stage with a high negative predictive value, and it is specifically beneficial in PMR/GCA patients with nonspecific symptoms.

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