Diagnostic Value and Limitations of FDG-PET for the Staging of Childhood Lymphomas.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3658-3658 ◽  
Author(s):  
Edita Kabickova ◽  
Jana Votrubova ◽  
David Sumerauer ◽  
Ester Mejstrikova ◽  
Ondrej Hrusak ◽  
...  

Abstract Abstract 3658 Poster Board III-594 Introduction Positron emission tomography with fluorine-18-fluorodeoxyglucose (FDG-PET) has the potential to detect malignant cells by their increased glycolysis. PET can detect early changes, before they are apparent on anatomic imaging. Whole-body PET can also detect lesions at unexpected sites. However, physiologic FDG uptake in non-malignant conditions limits the specificity of PET. PET is predominantly used in adult lymphoma patients, limited number of studies were published dealing with PET and PET/CT in childhood lymphomas. The aim of our study was to assess the usefulness of PET for initial staging of pediatric lymphomas and to evaluate benign pathologic causes of FDG uptake. Patients and methods Over a period of 5 years 86 children and adolescents with lymphoma (58 with Hodgkin's lymphoma, 28 with non-Hodgkin's lymphoma) had complete staging work-up including FDG-PET or PET/CT and were included into this prospective study. Patients were aged 4-19 years, 57 (66%) were boys. No patient had CNS lymphoma infiltration. PET findings were correlated with conventional staging methods (CSM) including CT, ultrasound, and bone marrow examination. Discordant findings were verified by MRI and follow-up radiographic studies including PET. Results PET revealed 40 additional lymphoma manifestations in 34% (26/86) of studies and correctly upstaged 15% (13/86) of patients. Only 2% (2/86) of children were not accurately staged by PET, when PET failed to visualize diffuse bone marrow infiltration (extent of 15% cells) in 1 patient, and missed small pulmonary metastases (≤6 mm) in 1 child. Compared with CSM, PET had significantly higher sensitivity (97% vs. 83%), specificity (100% vs. 89%), and significantly higher accuracy (98% vs. 84%). Physiologic thymic FDG uptake was observed in 15% (13) of patients; diffuse increased FDG bone marrow activity had 22% (19) of children, and intense FDG activity in fatty tissue occurred only in 8% (7) of patients. Conclusions PET imaging was highly sensitive in detecting all subtypes of pediatric lymphomas and has potential to accurately define the disease stage except the lungs, where CT has excellent sensitivity. Understanding of the physiologic FDG biodistribution and benign pathologic causes of FDG uptake is essential for accurate scan interpretation. Supported by grants: IGA NS/9997-4, NS/10480-3, MSM 0021620813 and MZO FNM 2005 Disclosures: No relevant conflicts of interest to declare.

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Madonna Adel Mikhail Ghaly ◽  
Aida Mohamed El Shibiny ◽  
Susan Adil Ali Abdul Rahim

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.


2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Maria E. S. Takahashi ◽  
Camila Mosci ◽  
Edna M. Souza ◽  
Sérgio Q. Brunetto ◽  
Elba Etchebehere ◽  
...  

Abstract Many efforts have been made to standardize the interpretation of 18F-FDG PET/CT in multiple myeloma (MM) with qualitative visual analysis or with quantitative metabolic parameters using various methods for lesion segmentation of PET images. The aim of this study was to propose a quantitative method for bone and bone marrow evaluation of 18F-FDG PET/CT considering the extent and intensity of bone 18F-FDG uptake: Intensity of Bone Involvement (IBI). Whole body 18F-FDG PET/CT of 59 consecutive MM patients were evaluated. Compact bone tissue was segmented in PET images using a global threshold for HU of the registered CT image. A whole skeleton mask was created and the percentage of its volume with 18F-FDG uptake above hepatic uptake was calculated (Percentage of Bone Involvement - PBI). IBI was defined by multiplying PBI by mean SUV above hepatic uptake. IBI was compared with visual analysis performed by two experienced nuclear medicine physicians. IBI calculation was feasible in all images (range:0.00–1.35). Visual analysis categorized PET exams into three groups (negative/mild, moderate and marked bone involvement), that had different ranges of IBI (multi comparison analysis, p < 0.0001). There was an inverse correlation between the patients’ hemoglobin values and IBI (r = −0.248;p = 0.02). IBI score is an objective measure of bone and bone marrow involvement in MM, allowing the categorization of patients in different degrees of aggressiveness of the bone disease. The next step is to validate IBI in a larger group of patients, before and after treatment and in a multicentre setting.


2012 ◽  
Vol 27 (2) ◽  
pp. 146-151 ◽  
Author(s):  
Kanhaiyalal Agrawal ◽  
Bhagwant Rai Mittal ◽  
Deepak Bansal ◽  
Neelam Varma ◽  
Radhika Srinivasan ◽  
...  

2008 ◽  
Vol 27 (1) ◽  
pp. 34-39 ◽  
Author(s):  
E. Roldán-Valadez ◽  
N. Ortega-López ◽  
E. Cervera-Ceballos ◽  
G. Valdivieso-Cárdenas ◽  
I. Vega-González ◽  
...  

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2981-2981 ◽  
Author(s):  
Chaitra S. Ujjani ◽  
Elizabeth Hill ◽  
Samer Nassif ◽  
Hongkun Wang ◽  
Yiru Wang ◽  
...  

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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