Abstract
The purpose of our study was to determine the value of different hybrid imaging combinations for the detection of focal and diffuse bone marrow infiltration in lymphoma. Patients with histologically proven lymphoma, who underwent both [18F]-FDG-PET/CT and whole-body MRI (including T1- and diffusion-weighted [DWI] sequences) within seven days, and a subsequent bone marrow biopsy, were retrospectively included. Three hybrid imaging combinations were evaluated: (1) [18F]-FDG-PET/CT; (2) [18F]-FDG-PET/T1; and (3) [18F]-FDG-PET/DWI. The presence of focal or diffuse bone marrow infiltration was assessed by two rater teams. Sensitivity, specificity, and accuracy for the detection of overall, focal, and diffuse bone marrow involvement were compared between the three hybrid imaging combinations. Overall, lymphomatous bone marrow involvement was found in 16/60 patients (focal, 8; diffuse, 8). Overall sensitivity, specificity, and accuracy were 81.3%, 95.5%, and 91.7% for [18F]-FDG-PET/CT; 81.3%, 97.7%, and 93.3% for [18F]-FDG-PET/T1; and 81.3%, 95.5%, and 91.7% for [18F]-FDG-PET/DWI. No statistically significant differences between the three imaging combinations were observed, based on overall bone marrow involvement, focal involvement, or diffuse involvement. The sensitivity of all three imaging combinations for detecting diffuse bone marrow involvement was only moderate (62.5% for all three combinations). Although the combination of [18F]-FDG-PET and T1-weighted MRI generally showed the best diagnostic performance for the detection of bone marrow involvement in lymphoma, it was not significantly superior to the two other hybrid imaging combinations. Since the sensitivity of all imaging combinations for the detection of diffuse bone marrow involvement was only moderate, bone marrow biopsy cannot be replaced by imaging as yet.
Highlights
Multifocal or diffuse bone marrow involvement in lymphoma patients is a criterion for Ann Arbor stage IV disease, and often has a considerable effect on therapy and prognosis [1]
Informed consent was waived.A database search was performed to identify all patients with (1) histologically proven lymphoma and subtype classification according to the current classification of the World Health Organization (WHO) for hematologic and lymphoid malignancies, and who had (2) undergone both pre-therapeutic [18F]-FDG-PET/CT and additional whole-body magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) at 3.0 Tesla, and in whom (3) a pre-therapeutic bone marrow biopsy and histological work-up had been performed in-house, by a reference pathologist specializing in hematological malignancies
Eighteen patients were diagnosed with Hodgkin lymphoma (HL), 16 with diffuse large B-cell lymphoma (DLBCL), 11 with follicular lymphoma (FL), six with extranodal marginal zone Bcell lymphoma of the mucosa-associated lymphoid tissue (MALT), four with mantle cell lymphoma (MCL), four with nodal marginal zone lymphoma, and one with anaplastic large cell lymphoma (ALCL) (Table 1)
Summary
Multifocal or diffuse bone marrow involvement in lymphoma patients is a criterion for Ann Arbor stage IV disease, and often has a considerable effect on therapy and prognosis [1]. Detection of bone marrow involvement— diffuse marrow infiltration—on [18F]-FDG-PET/CT depends heavily on the histologic lymphoma subtype. Indolent lymphomas, such as follicular lymphomas are challenging in that regard. BMB is associated with the small but recognized risks of hemorrhage or fracture, and is frequently regarded as painful, when performed without conscious sedation. Another limitation of this biopsy technique is the lack of image guidance, which can lead to false-negative results in cases of focal bone involvement. There are currently no guidelines, or sufficient data, that support the notion that use of image-guided biopsy, rather than standard iliac crest biopsy, has a clinically relevant effect on staging, or improves patient survival
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
