Abstract
PurposeTo evaluate the utility of SUVmax on FDG-PET and chemical shift imaging (CSI) on MRI in the differentiation of intertrabecular metastasis (ITM) from hematopoietic bone marrow hyperplasia (HBMH).Patients and methodsWe retrospectively evaluated 54 indeterminate focal bone marrow lesions in 44 patients detected on FDG-PET. The lesions were assigned to the metastasis group (M group, 29 lesions of 24 patients) and the non-metastasis group (non-M group, 25 lesions of 20 patients) based on the follow-up or the histopathological studies. The lesions were assessed with the maximum standardized uptake value (SUVmax) on FDG-PET CT images and signal change ratio (SCR) on CSI.ResultsThe median SUVmax were 5.62 and 2.91; the median SCR were − 0.08 and − 34.8 in M and non-M groups respectively, with significant difference (p < 0.001). With ROC curve analysis, the optimal cutoff value of SUVmax was 4.48 with a sensitivity of 72.4%, a specificity of 100%, and AUC of 0.905. The cutoff value of SCR was − 6.15 with a sensitivity of 82.8%, a specificity of 80%, and AUC of 0.818.ConclusionFDG-PET and CSI on MRI are useful in distinguishing ITM from HBMH. Though their sensitivities are similar, the specificity of FDG-PET was higher than that of MRI.
Highlights
Bone metastasis is classified into four types on the basis of the accompanying bone responses: osteolytic, osteoblastic, mixed, and intertrabecular types
No significant differences in age, red blood cell count, hemoglobin level, and hematocrit level were noted between the groups
This study examined the efficacy of fluoro-2-deoxy-d-glucose PET (FDG-PET) computed tomography (CT) and Magnetic resonance imaging (MRI) in differentiating Intertrabecular metastasis (ITM) from non-metastatic lesions in patients with bone marrow lesions where abnormal accumulation was indicated on FDG-PET CT
Summary
Bone metastasis is classified into four types on the basis of the accompanying bone responses: osteolytic, osteoblastic, mixed, and intertrabecular types. Intertrabecular metastasis (ITM) is characterized by tumor growth without significant trabecular bone changes. This type of bone metastasis is most common, reportedly accounting for approximately 37% of all cases of metastatic bone lesions at autopsy; it is often found in cases of small-cell lung carcinoma, hepatocellular carcinoma, and hematological malignancies [1]. Magnetic resonance imaging (MRI) has been reported to be reliable to detect ITM [2]. A meta-analysis shows 18F-fluoro-2-deoxy-d-glucose PET (FDG-PET) has a superior diagnostic ability for metastasis from lung cancer than MRI and bone scintigraphy [3]. There have been no studies focusing on the diagnostic performance of FDGPET in detecting ITM
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