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European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-11-2009 | Original Article

Analysis of ¹⁸F-FDG PET diffuse bone marrow uptake and splenic uptake in staging of Hodgkin’s lymphoma: a reflection of disease infiltration or just inflammation?

Authors: Pierre Y. Salaun, Thomas Gastinne, Caroline Bodet-Milin, Loïc Campion, Pierre Cambefort, Anne Moreau, Steven Le Gouill, Christian Berthou, Philippe Moreau, Françoise Kraeber-Bodéré

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 11/2009

Abstract

Purpose

¹⁸F-FDG PET has been successfully evaluated in the management of Hodgkin’s lymphoma (HL) and the most recent international guidelines recommended ¹⁸F-FDG PET for initial staging and final therapeutic assessment. However, ¹⁸F-FDG PET diffuse bone marrow uptake (BMU) and splenic uptake (SU) are frequently observed at the initial imaging and remain difficult to analyse. The aim of this retrospective study was to evaluate the significance of ¹⁸F-FDG diffuse BMU and SU in initial staging of HL.

Methods

A total of 106 patients (median age: 31 years, range: 9–81, 51 female, 55 male) underwent ¹⁸F-FDG PET/CT for initial staging of HL. BMU level was assessed visually according to liver uptake (1 = below liver uptake, 2 = corresponding to liver uptake, 3 = above liver uptake) and semi-quantitatively using the maximum standardized uptake value (SUV_max) measured in the sacral area. SU was assessed visually according to liver uptake (1 = below liver uptake, 2 = corresponding to liver uptake, 3 = above liver uptake). These data were compared with the patient’s characteristics including sex, age, Ann Arbor staging, bulky disease (tumour burden > 10 cm), presence of B symptoms, bone foci on PET (n = 106), bone marrow involvement (BMI) on biopsy (n = 75), leukocyte count (n = 74), lactic dehydrogenase (LDH) (n = 87), C-reactive protein (CRP) (n = 83) and fibrinogen (n = 60). Univariate and multivariate analyses were performed.

Results

Multivariate analysis found an independent correlation between BMU visual grading and CRP level (p = 0.007). For semi-quantitative BMU evaluation, multivariate analysis found an independent correlation between sacral SUVs and CRP level (p = 0.032) and Ann Arbor stage (p = 0.005). No BMI was found in patients who presented with SUV_max below 3.4. For splenic evaluation, multivariate analysis found an independent correlation between SU and splenic foci (p = 0.034). No statistical link was found between SU and inflammatory markers.

Conclusion

Our study demonstrates that diffuse BMU at initial staging of HL could be due to bone marrow involvement but more likely to bone marrow inflammatory change and that diffuse SU in contrast is probably more associated with disease involvement than with inflammatory change.

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Title: Analysis of 18F-FDG PET diffuse bone marrow uptake and splenic uptake in staging of Hodgkin’s lymphoma: a reflection of disease infiltration or just inflammation?
Authors: Pierre Y. Salaun
Thomas Gastinne
Caroline Bodet-Milin
Loïc Campion
Pierre Cambefort
Anne Moreau
Steven Le Gouill
Christian Berthou
Philippe Moreau
Françoise Kraeber-Bodéré
Publication date: 01-11-2009
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 11/2009
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-009-1183-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Analysis of ¹⁸F-FDG PET diffuse bone marrow uptake and splenic uptake in staging of Hodgkin’s lymphoma: a reflection of disease infiltration or just inflammation?

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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