18F-FDG super bone marrow uptake: A highly potent indicator for the malignant infiltration

Area of Science:

• Nuclear Medicine
• Oncology
• Hematology

Background:

• Bone marrow (BM) uptake of 2-deoxy-2-(fluorine-18) fluoro-D-glucose (F-FDG) can be variable.
• Distinguishing malignant infiltration (MI) from physiological uptake is crucial for diagnosis.

Purpose of the Study:

• To investigate if markedly increased F-FDG uptake in the bone marrow (BM), termed "super bone marrow uptake" (super BMU), is indicative of malignant infiltration (MI).
• To evaluate the diagnostic performance of super BMU for bone marrow MI using F-FDG PET/CT.

Main Methods:

• Retrospective review of 31 patients with super BMU (F-FDG uptake in BM similar to or higher than the brain) from April 2008 to December 2015.
• Semiquantification of F-FDG uptake using SUVmax and BM to cerebellum (BM/C) ratio.
• Pathological diagnosis of super BMU origin, alongside analysis of blood parameters and fever.

Main Results:

• Bone marrow MI was diagnosed in 93.5% of patients with super BMU, predominantly from acute leukemia and aggressive lymphoma.
• Super BMU group showed significantly higher F-FDG uptake and BM/C ratio compared to control groups (P < 0.001).
• Diagnostic specificity for bone marrow MI reached 91.4% (BM/C ratio cutoff 0.835) and 95.7% (SUVmax cutoff 6.560).

Conclusions:

• Super bone marrow uptake (super BMU) is a highly potent indicator for diagnosing bone marrow malignant infiltration (MI).
• F-FDG PET/CT findings, particularly super BMU, aid in differentiating malignant from non-malignant bone marrow conditions.
• Associated hematological abnormalities (leukopenia, anemia, thrombocytopenia) were noted in patients with bone marrow MI.