Usefulness of 18 F-FDG PET/CT for the evaluation of bone marrow involvement in patients with high-grade non-Hodgkin's lymphoma

Abstract

Purpose To assess the usefulness of 18 F-fluorodeoxyglucose PET/CT in the detection of bone marrow (BM) involvement of high-grade non-Hodgkin's lymphoma (NHL). Methods One hundred twenty patients with newly diagnosed diffuse large B-cell lymphoma or peripheral T-cell lymphoma between January 2007 and June 2011, who received BM trephine biopsy and 18 F-FDG PET/CT before chemotherapy, were included in this retrospective study. We reviewed their 18 F-FDG PET/CT images and bone marrow biopsy (BMB) results. After reviewing the images, we reviewed the medical records and radiological findings of interesting patients. Results There were 23 18 F-FDG PET/CT scans in which the marrow was considered to be abnormal (either positive or equivocal), and 97 18 F-FDG PET/CT scans were regarded as having negative FDG uptake. Of 120 patients, 100 (83.3 %) had a concordant result of BM interpretation between 18 FFDG PET/CT and BMB, and the remaining 20 patients had discordant results. Among 23 patients with either positive or equivocal 18 F-FDG PET/CT scans, 1 of 12 patients with 'positive' 18 F-FDG PET/CT had a lymphomatous involvement on BMB. In contrast, 10 of 11 patients with 'equivocal' BM hypermetabolism were reported as having positive involvement by BMB. Patients with abnormal 18 F-FDG PET/CT had significantly higher mSUVhighest than those with normal FDG-PET/CT. Conclusions 18 -FDG PET/CTand BMB are complementary techniques in assessing the presence of BM involvement in patients with high-grade NHL. The increasing availability of 18 F-FDG PET/CTwill raise the need for additional biopsy for FDG-avid lesions, especially in patients with negative standard BMBs. 18 F-FDG PET/CT can be useful as a decisionmaking tool for determining whether to perform a standard BMB or targeted biopsy to the FDG-avid lesion as an initial staging procedure.A direct bone biopsy for FDGpositive bone lesions should be included in staging guidelines in future. In 18 F-FDG PET/CT-negative cases, BMB is still a powerful procedure, but BMB alone is insufficient for full evaluation of BM. © Korean Society of Nuclear Medicine 2012.