Bone involvement in patients with lymphoma: the role of FDG-PET/CT |
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Authors: | Niklaus G Schaefer Klaus Strobel Christian Taverna Thomas F Hany |
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Institution: | (1) Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland;(2) Department of Internal Medicine, Clinic for Medical Oncology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland |
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Abstract: | Purpose To evaluate the diagnostic impact and clinical significance of FDG-avid bone lesions detected by FDG-PET/CT in patients with
lymphoma.
Methods The study population comprised 50 consecutive patients (mean age 41.7±15.5 years; 27 female, 23 male; 41 staging, 9 restaging)
with Hodgkin’s disease (n=22) or aggressive non-Hodgkin’s lymphoma (n=28) in whom FDG-avid bone lesions were detected by FDG-PET/CT. All patients had either direct biopsy of the FDG-avid bone
lesion (n=18), standard bone marrow biopsy at the iliac crest (BMB; n=43) or both procedures (n=11). In 15 patients, additional MRI of the bone lesions was performed. All patients underwent FDG-PET/CT after the end of
treatment. All CT images of FDG-PET/CT scans were analysed independently regarding morphological osseous changes and compared
with FDG-PET results.
Results In the 50 patients, 193 FDG-avid lesions were found by PET/CT. The mean standardised uptake value was 6.26 (±3.22). All direct
bone biopsies (n=18) of the FDG-avid lesions proved the presence of lymphomatous infiltration. BMB (n=43) was positive in 12 patients (27.9%). In CT, 32 of 193 (16.6%) lesions were detected without the PET information. No additional
morphological bone infiltration was detected on CT compared with FDG-PET. All morphological bone alterations on CT scans persisted
after the end of therapy. Additional PET/CT information regarding uni- or multifocal bone involvement resulted in lymphoma
upstaging in 21 (42%) patients compared with the combined information provided by CT and BMB.
Conclusion In patients with FDG-avid bone lesions, FDG-PET is superior to CT alone or in combination with unilateral BMB in detecting
bone marrow involvement, leading to upstaging in a relevant proportion of patients. |
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Keywords: | FDG-PET/CT Lymphoma Bone Bone marrow Biopsy |
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