Bone Marrow SUVmax Research Articles

Comparison of [18F]fluciclovine and [18F]FDG PET/CT in Newly Diagnosed Multiple Myeloma Patients

Purpose[18F]FDG PET/CT in multiple myeloma (MM) is currently the best technology to demonstrate patchy and extramedullary disease. However, [18F]FDG PET has some limitations, and imaging with alternative tracers should be explored. In this study, we aimed to evaluate the performance of [18F]fluciclovine PET compared to [18F]FDG PET in newly diagnosed MM patients.ProceduresThirteen newly diagnosed transplant eligible MM patients were imaged both with [18F]FDG PET/CT and [18F]fluciclovine PET/CT within 1 week in a prospective study. The subjects were visually assessed positive or negative for disease. The number of lesions and the SUVmax of selected lesions were measured for both tracers. Furthermore, tracer uptake ratios were obtained by dividing lesion SUVmax by blood or bone marrow SUVmax. Between-group differences and correlations were assessed with paired t-tests and Pearson tests. Bone marrow SUVs were compared to bone marrow plasma cell percentage in biopsy samples.ResultsNine subjects were assessed positively by [18F]FDG PET (69%) and 12 positives by [18F]fluciclovine PET (92%). All positive subjects had [18F]fluciclovine scans that were qualitatively scored as easier to interpret visually than the [18F]FDG scans. The number of lesions was also higher; seven of nine subjects with distinct hot spots on [18F]fluciclovine PET had fewer or no visible lesions on [18F]FDG PET. The mean lesion SUVmax values were 8.2 and 3.8 for [18F]fluciclovine and [18F]FDG, respectively. The mean tumour to blood values were 6.4 and 2.0 for [18F]fluciclovine and [18F]FDG, and the mean ratios between tumour and bone marrow were 2.1 and 1.5 for [18F]fluciclovine and [18F]FDG. The lesion SUVmax and ratios were significantly higher for [18F]fluciclovine (all p < 0.01).Local [18F]fluciclovine SUVmax or SUVmean values in os ilium and the percentage of plasma cells in bone marrow biopsies were linearly correlated (p = 0.048). There were no significant correlations between [18F]FDG SUVs and plasma cells (p = 0.82).ConclusionsBased on this pilot study, [18F]fluciclovine is a promising tracer for MM. The visual and semi-quantitative evaluations indicate that [18F]fluciclovine PET/CT can out-perform [18F]FDG PET/CT at diagnosis.

Metabolic Activity of Visceral Adipose Tissue Is Associated with Metastatic Status of Lymph Nodes in Endometrial Cancer: A 18F-FDG PET/CT Study.

Obesity contributes to increased cancer incidence and aggressiveness in patients with endometrial cancer. Inflamed metabolic activity of visceral adipose tissue (VAT) is regarded as a key underlying mechanism of adverse consequences of obesity. The aim of this study was to investigate the association between inflammatory metabolic activity of VAT evaluated by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and metastatic status of lymph nodes (LN) in patients with endometrial cancer. In total, 161 women with newly diagnosed endometrial cancer, who received preoperative 18F-FDG PET/CT, were enrolled. VAT inflammatory metabolic activity was defined as V/S ratio and measured from the maximum standardized uptake value (SUVmax) of VAT normalized to the SUVmax of subcutaneous adipose tissue (SAT). The positive LN metastasis group exhibited a significantly higher V/S ratio than the negative LN metastasis group. Systemic inflammatory surrogate markers including high sensitivity C-reactive protein, spleen SUVmax, and bone marrow SUVmax were also higher in the LN metastasis group than in the negative LN metastasis group, showing significant correlations with V/S ratio. In multivariate logistic regression analysis, V/S ratio was independently associated with LN metastasis. V/S ratio is independently associated with the LN metastasis status in patients with endometrial cancer. This finding could be useful as a potential surrogate marker of obesity-induced VAT inflammation associated with tumor aggressiveness.

Radiological Characteristics of Patients With Anti-MDA5-Antibody-Positive Dermatomyositis in 18F-FDG PET/CT: A Pilot Study.

Objective: To elucidate the 18F-fluorodeoxyglucose (FDG) PET/CT characteristics and its prognostic value in the patients with anti-melanoma differentiation associated protein 5 antibody positive (anti-MDA5+) dermatomyositis (DM).Methods: This retrospective cross-sectional study included 26 patients with anti-MDA5+ DM and 43 patients with anti-MDA5 negative (anti-MDA5–) idiopathic inflammatory myopathy (IIM) who were examined by 18F-FDG PET/CT from January 1, 2017 to December 31, 2020. The maximum standardized uptake value (SUVmax) of multiple organs and other clinical characteristics of the patients were measured and analyzed.Results: Compared with the anti-MDA5– group, the patients in the anti-MDA5+ group showed higher bilateral lung SUVmax (p = 0.029), higher SUVmax of spleen (p = 0.011), and bone marrow (p = 0.048). Significant correlations between the spleen SUVmax and serum ferritin levels (r = 0.398, p < 0.001), erythrocyte sedimentation rate (ESR) (r = 0.274, p = 0.023), platelet count (r = −0.265, p= 0.028), myositis disease activity assessment score (r = 0.332, p = 0.005), bone marrow SUVmax (r = 0.564, p < 0.001), and bilateral lung SUVmax (r = 0.393, p < 0.001) were observed.Conclusion: 18F-FDG PET/CT was found valuable in quantifying the pulmonary focal inflammation and potentially unveil the distinctive characteristics and pathophysiological mechanisms in the patients with anti-MDA5+ DM.

18F-FDG PET/CT Associates With Disease Activity and Clinical Recurrence of AOSD Patients.

Objective: The purpose of this study was to explore the value of 18F-FDG PET/CT in monitoring the disease activity and predicting the prognosis of the Adult-onset Still's disease (AOSD).Methods: We retrospectively analyzed the electronic medical records of 45 AOSD patients who underwent 18F-FDG PET/CT in the Second Xiangya Hospital. PET/CT imaging and clinical information were retrospectively reviewed and analyzed. 18F-FDG uptake was assessed by measuring standard uptake value (SUV) in the spleen, liver, bone marrow, and lymph nodes. The spleen-to-liver ratio of the SUVmax (SLRmax) and SUVmean (SLRmean), the bone-to-liver ratio of the SUVmax (BLRmax), and SUVmean (BLRmean), and the lymph nodes-to-liver ratio of the SUVmax (LyLRmax) were calculated. Clinical and laboratory information were collected and evaluated for association with metabolic parameters of 18F-FDG PET/CT. The influencing factors for recurrence within 1 year were analyzed to determine whether 18F-FDG PET/CT can predict the prognosis of AOSD patients.Results: Elevated 18F-FDG uptake could be observed in bone marrow, spleen, and lymph nodes of AOSD patients. Correlation analysis between 18F-FDG uptake of organs and laboratory examinations showed that SLRmean positively correlated with LDH, AST, ferritin, and the systemic score (r = 0.572, 0.353, 0.586, and 0.424, P < 0.05). The SLRmean had the highest correlation with ferritin (r = 0586, P < 0.001). All metabolic parameters in spleen, including SUVmax, SUVmean, SLRmax, and SLRmean, are positively correlated with LDH level (r = 0.405, 0.539, 0.481, and 0.572, P < 0.05). Bone marrow SUVmax, BLRmax, and BLRmean were correlated with C-reactive protein (CRP) level (r = 0.395, 0.437, and 0.469, P < 0.05). Analysis of the influencing factors of recurrence within 1 year showed that the spleen SUVmax, spleen SUVmean, SLRmax, SLRmean, ferritin, and the systemic score of the recurrence group was significantly higher than the non-recurrence group (P < 0.05). The SLRmean cutoff of 1.66 with a sensitivity of 72.7% and specificity of 80.0% had the highest performance in predicting recurrence.Conclusion: The glucose metabolism of the liver, spleen, and bone marrow of AOSD patients were correlated with laboratory inflammatory indicators and system score, suggesting that 18F-FDG PET/CT could be applied to evaluate disease activity. Moreover, spleen 18F-FDG uptake may be a potential biomarker for predicting clinical prognosis of AOSD patients.

Prognostic value of F-18 fluorodeoxyglucose uptake in primary tumor and reticuloendothelial system in patients with head and neck cancer

Aim: The aim of this study was to investigate the prognostic value of FDG uptake in primary tumor and reticuloendothelial system at 18 Fluorine-fluorodeoxyglucose positron emission tomography / computed tomography (18F-FDG PET / CT) in patients with head and neck cancer.Materials and Methods: A total of 56 head and neck cancer patients who underwent 18F-FDG PET / CT imaging in our clinic for staging were included in study. A circular volume of interest (VOI) was drawn which include tumor tissue on axial images and thereafter SUVmax value of the primary tumor was measured. Bone marrow SUVmax was measured at Lumbal 3-5 th vertebraes. Bone marrow-to-liver uptake ratio (BLR) value was calculated by dividing the bone marrow SUVmax value to liver SUVmax. Bone marrow-to-spleen uptake ratio (BSR) ratio value was calculated by dividing bone marrow SUVmax value to the spleen SUVmax.Results: Forty-five were male and 11 were female of the 56 patients included in the study. The average age was 62.71 ± 14.3. The SUVmax value of primary tumor and age had a significant predictive value in terms of overall survival (p = 0.027 and p = 0.037, respectively). There was a significant difference in overall survival when using 13.6 cut off for SUVmax and 65.5 cut off for age (p = 0.005, p = 0.019, respectively). Age (≥65.5), distant metastasis and SUVmax of primary tumor (≥13.6) values were independent prognostic factors in the multivariate analysis. The bone marrow SUVmax value and BLR and BSR ratios of the patients did not have a significant prognostic value in both univariate and multivariate analysis.Conclusion: The SUVmax value of the primary tumor in 18F-FDG PET / CT in patients with head and neck cancer, had both predictive and independent prognostic value. Bone marrow SUVmax, BLR and BSR values which shows FDG uptake on RES system, were not predictive and prognostic.

Quantitative CT Detects Undiagnosed Low Bone Mineral Density in Oncologic Patients Imaged With 18F-FDG PET/CT.

We assessed the prevalence of low bone mineral density (BMD) in oncologic patients undergoing F-FDG PET/CT. This is a retrospective analysis of 100 patients who underwent F-FDG PET/CT at a single center from October 2015 till May 2016. Quantitative CT (QCT) was used to assess BMD at the lumbar spine (BMDQCT) and femoral necks (BMDCTXA). SUVmax was used to evaluate metabolic activity of the bone marrow. Risk of osteoporosis-related fractures was calculated with femoral neck BMDCTXA and the FRAX algorithm, which was compared against measurements of CT attenuation of the trabecular bone at L1 (L1HU). Osteoporosis and osteopenia were respectively present in 16% and 46% of patients 50 years and older. Bone marrow SUVmax was correlated with BMD at the lumbar spine (ρ = 0.36, P < 0.001). Increased age and low marrow SUVmax were associated with low BMDQCT at the lumbar spine (both P < 0.001), whereas increased age, female sex, and low marrow SUVmax were associated with low BMDCTXA at the femoral necks (P < 0.001, P < 0.001, P = 0.01, respectively). L1HU had an area under the curve of 0.95 (95% confidence interval [CI], 0.90-0.99) for detecting increased risk for osteoporosis-related fracture, with best threshold of 125.8 HU (95% CI, 115.7-144.9) yielding sensitivity of 100% (95% CI, 0.92-1.00), specificity of 0.90 (95% CI, 0.76-0.97), and accuracy of 0.91 (95% CI, 0.79-0.97). Low BMD is frequent in oncologic patients undergoing F-FDG PET/CT. Decreased F-FDG avidity of the bone marrow correlates with decreased BMD, validating the link between osteoporosis and bone marrow fat. L1HU could be a simple and accurate approach for detecting patients at risk for osteoporosis-related fractures using PET/CTdata.

Association of glucose uptake of visceral fat and acute myocardial infarction: a pilot 18F-FDG PET/CT study

BackgroundInflamed visceral adipose tissue (VAT) facilitates chronic inflammation in atherosclerotic lesions thereby leading to increased risk of coronary artery disease (CAD). In this study, we evaluated the glucose uptake of VAT and the carotid artery with 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) and their association with CAD, including acute myocardial infarction (AMI).MethodsA total of 90 participants were enrolled (32 with AMI, 33 with chronic stable angina; CSA, and 25 control participants) and undertook 18F-FDG PET/CT. VAT glucose uptake was measured by using maximum standardized uptake value (SUVmax) of VAT region. The target-to-background ratio (TBR) of carotid artery was defined as the SUVmax of carotid artery divided by the SUVmax of jugular vein. The SUVmax of spleen, bone-marrow (BM), and high-sensitivity C-reactive protein (hsCRP) were used for the assessment of systemic inflammatory activity.ResultsVAT SUVmax was highest in participants with AMI, intermediate in participants with CSA, and lowest in control participants. Carotid artery TBR and systemic inflammatory surrogate markers including spleen SUVmax, BM SUVmax, and hsCRP were also higher in the AMI group than in the CSA or control group. Furthermore, VAT SUVmax showed significant positive correlation with carotid artery TBR, spleen SUVmax, BM SUVmax, and hsCRP. In multivariate linear regression and logistic regression analyses, VAT SUVmax was independently associated with carotid artery TBR and AMI.ConclusionsGlucose uptake of VAT assessed by 18F-FDG PET/CT was associated with the severity of CAD and synchronized with the carotid artery inflammation in participants with CAD.

SAT0557 RESIDUAL DISEASE ACTIVITY IN ADULT-ONSET STILL’S DISEASE: QUALITATIVE AND QUANTITATIVE ANALYSIS OF A SERIES OF 18F FDG-PET/MR

Background:Adult-onset Still’s disease (AOSD) is a systemic autoinflammatory disorder characterized by episodes of spiking fever, the presence of an evanescent pink-salmon rash, arthritis/arthralgias, sore throat and increased inflammatory serum markers. The diagnosis is clinical and needs the exclusion of potential mimickers such as infections and lymphoproliferative disorders. Currently, a specific diagnostic test to assess the disease activity is not available.Objectives:To define the residual disease activity in AOSD and establish a possible response to therapy through18F-FDG PET/MR imaging technique.Methods:23 patients affected by AOSD and 24 controls underwent18F-FDG PET/MR between 2014 and 2018. A total of 5418F-FDG PET/MR were analysed. AOSD patients were diagnosed according to the Yamaguchi’s criteria and were in follow-up at the Rheumatology Unit of Padova University Hospital. The controls were chosen among non-AOSD patients with a previous diagnosis of solid tumors (lymphomas excluded). Aqualitative analysisof PET/RM carried out by a Nuclear Medicine Specialist and asemiquantitative analysiscarried out by measuring SUVs-to-liver (Standardized Uptake Value) for spleen, bone marrow (BM), lymph nodes and pharynx were performed. A SUVmax BM/SUVmean liver higher than 2.09 was set up as significant area of uptake for each organ considered. This threshold was calculated by adding the standard deviation multiplied by 2 at the mean ratio between SUVmax BM and SUVmean liver of the control group. The Pouchot score for disease activity was calculated for each subject. The distribution of the variables was investigated by Shapiro-Wilk test. The analysis of the association between the variables was carried out using the Mann-Whitney U test.Results:AOSD patients present areas of focal18F-FDG uptake mainly in BM, lymph nodes, pharynx, spleen and salivary glands. Sites of uptake in spleen were found in 3.3% of PET/MR, in BM in 23.3%, in lymph nodes in 23.3% and in pharynx in 36.6% of PET/RM respectively. Eleven/thirty (47.8%) patients were defined as “positive” since the uptake was higher than liver, and twelve/thirty (52.2%) were defined as “negative” since the uptake was lower than liver, regardless of SUVs and clinical manifestations. A semi-quantitative analysis assessed whether the values of the SUVmax BM/liver were higher than the cut-off of 2.09 in “positive” PET/MR and lower in the “negative” ones and if the clinical manifestations were present or absent in agreement with the evaluation of SUVs for each patient. BM was found to be active (SUVmax ratio &gt; of 2.09) in 7 out of 11 patients when the PET/MR was defined “positive”, while only in 1 case out of 12 BM SUVmax was &gt;2.09 when the exam was “negative”. Clinical manifestations were present in 10 out of 11 AOSD with a “positive” scan and in 7 out of 11 with both a “positive” scan and a SUV max BM/liver &gt;2.09. Clinical manifestations were present in 1 out of 12 patients with a “negative” scan, while in 10 out of 12 cases with both a negative scan and a SUV max BM/liver &lt;2.09 were absent. Six patients repeated PET/MR during follow-up. The values of the SUVmax BM/liver significantly decreased after anti IL-1β treatment with anakinra. In two cases in which anakinra was deferred, the BM SUVmax values exceeded the cut-off of 2.09 despite the patients did not complain any symptom or inflammation markers increase.Conclusion:18F FGD-PET/MR could be able to evaluate the disease activity in AOSD when clinical manifestations and serum markers are not sufficient to establish it. The uptake on BM seems quite sensitive in pointing out the disease severity and in assessing the response to anti IL-1β therapy.18F PET/MR is an accurate and repeatable method, however further studies are required to validate its applicability in routinary clinical practice.Disclosure of Interests:None declared

Evaluation of the Prognostic Value of Positron Emission Tomography-Computed Tomography (PET-CT) at Diagnosis and Follow-up in Transplant-Eligible Newly Diagnosed Multiple Myeloma (TE NDMM) Patients Treated in the Phase 3 Cassiopeia Study: Results of the Cassiopet Companion Study

Evaluation of the Prognostic Value of Positron Emission Tomography-Computed Tomography (PET-CT) at Diagnosis and Follow-up in Transplant-Eligible Newly Diagnosed Multiple Myeloma (TE NDMM) Patients Treated in the Phase 3 Cassiopeia Study: Results of the Cassiopet Companion Study

Increased bone marrow SUVmax on 18F-FDG PET is associated with higher pelvic treatment failure in patients with cervical cancer treated by chemoradiotherapy and brachytherapy

ABSTRACTThe aim of this study was to evaluate if bone marrow (BM) SUVmax measured on pre-treatment 18F-FDG PET/CT predicts the clinical outcome of locally advanced cervical cancer (LACC). We recruited retrospectively patients with LACC who underwent staging 18F-FDG PET/CT and had baseline blood tests, then treated by chemoradiation therapy (CRT), followed by image-guided adaptive brachytherapy (IGABT). BM SUVmax was calculated and correlated to inflammatory blood markers. Tumor size and pelvic lymph node involvement were evaluated on baseline MRI. Prognostic value of SUV uptake and blood markers regarding overall survival (OS), pelvic and extra-pelvic recurrence-free survival (PRFS and EPRFS respectively) was assessed using Cox models with adjusted p-values. 116 patients with FIGO stage Ib-IVa cervical cancer, treated between 2005 and 2014, were analyzed. The median follow-up was 75.5 months. BM SUVmax was significantly correlated to tumor SUVmax. In multivariate analysis, PRFS was significantly poorer in patients with high BM SUVmax (>2.8) and neutrophilia (p < .05). Tumor size (>5 vs ≤5 cm) could predict PRFS, EPRFS and OS (p < .05). In our cohort, FIGO stage (I-II vs III-IV), pelvic lymph node involvement and tumor SUVmax (>12 vs ≤12) were not prognostic for OS or pelvic and extra-pelvic relapses. Patients with LACC and high BM SUVmax on 18F-FDG PET have worse PFRS following CRT plus IGABT. These results can be potentially explained by the pro-inflammatory role of the tumor microenvironment and G-CSF expressed by tumor cells. These data support the role of PET as a potential indicator of disease aggressiveness beyond tumor staging.

Standardization of 18F-FDG PET/CT According to Deauville Criteria for MRD Evaluation in Newly Diagnosed Transplant Eligible Multiple Myeloma Patients: Joined Analysis of Two Prospective Randomized Phase III Trials

Standardization of 18F-FDG PET/CT According to Deauville Criteria for MRD Evaluation in Newly Diagnosed Transplant Eligible Multiple Myeloma Patients: Joined Analysis of Two Prospective Randomized Phase III Trials

OC-0394: Pretreatment bone marrow SUVmax in locally advanced cervical cancer: a novel prognostic biomarker?

OC-0394: Pretreatment bone marrow SUVmax in locally advanced cervical cancer: a novel prognostic biomarker?

PET-CT Manifestation and Clinical Analysis of Waldenstrom Macroglobulinemia

To investigate the PET-CT manifestation and clinical features of patients with Waldenstrom macroglobulinemia(WM) . The clinical features, laboratorial examination results and PET-CT manifestation of 12 patients with WM were analyzed retrospectively. The average age of 12 patients with WM was 63.5 years old, the most common incipient symptoms were fatigue and hyperviscosity syndrome. The median SUVmax of bone marrow was 4.9 (range of 2.1 to 21.9), with diffusely increased 18F-FDG uptake in all the patients. In 6 patients, the median SUVmax of splenomegaly and lymphadenectasis was 3.2 (range of 2.3 to 5.2) and 5.2 (range of 3.6 to 11.2), respectively. The SUVmax of bone marrow, splenomegaly and lymphadenectasis did not related with white blood cell count, hemoglobin level, blood platelet count, β2- microglobulin level and serum monoclonal IgM of such patients, respectively (both P>0.5). In univariate analysis, serum monoclonal IgM and the SUVmax of lymphadenectasis were found to be the prognostic factors (both P<0.5). The 18F-FDG PET-CT feature of Waldenstrom macroglobulinemia has some characteristics which are helpful for setting up the clinical therapeutic schedule.

Prognostic Significance of Bone Marrow Infiltration Detected By PET-CT in Newly Diagnosed Diffuse Large B Cell Lymphoma

PurposeThe aim of this study was to examine the prognostic value of bone marrow involvement (BMI) assessed by PET-CT in treatment-naïve patients with diffuse large B-cell lymphoma (DLBCL).Patients and methodsAll patients from a single centre diagnosed as DLBCL between 2005 and 2014 had data extracted from staging PET-CT, bone marrow biopsy (BMB), and treatment records. The final diagnosis of BMI was defined as: (i) positive bone marrow biopsy; (ii) positive PET-BMI confirmed by guided biopsy or targeted MR imaging; (iii) concomitant disappearance of bone marrow uptake and uptake in other lymphoma lesions on PET-CT after R-chemotherapy.ResultsOf 169 patients, 20 patients (12%) had BMI on BMB, whereas 35 patients (21%) had positive BMI according to PET-CT findings (PET-BMI(+)). Thirty-three out of the 35 patients with PET-BMI(+) showed a focal pattern and 2 a diffuse pattern, respectively. In multivariate analyses, PET-BMI(+) remained significant for overall survival (OS) (HR 2.90, 95%CI 1.21−6.96, P =0.017) while progressive-free survival (PFS) was significant only in univariate analysis (P<0.001) (Table 1). Among patients with PET-BMI(+) at diagnosis (N=35), patients with SUVmax of bone marrow (SUVmax(BM)) more than 8.6 were significantly associated with high IPI score (3−5) (P =0.002) and worse PFS and OS (P =0.025 and P =0.002, respectively) (Figure 1). In the 68 stage IV cases, three-year OS was higher for patients with negative PET-BMI (PET-BMI (−)) than patients with PET-BMI(+) (84.2%¡À6.5% vs. 44.1%¡À8.6%, respectively; P =0.003) while PFS only shown a trend of statistic significance (P =0.077) between the 2 groups, with estimates of 3-year PFS at 49.3%¡À9.2% and 28.6%¡À7.6%, respectively (Figure 2). Among the 69 patients with inter-risk of IPI (2−3), patients with PET-BMI(+) (N=21) had significantly inferior PFS and OS than patients with PET-BMI(−) (N=48) (P =0.009 and P<0.001, respectively) (Figure 3).ConclusionsOur data raised several important issues about the predictive significance of BMI assessed by PET-CT in DLBCL: (i) The bone marrow status assessed by PET-CT is an independent predictor of OS independent of IPI; (ii) For baseline PET-BMI(+) patients, the optimal cutoff value of SUVmax(BM) to predict the survival outcomes was 8.6; (iii) In patients with stage IV disease, worse survival outcomes were observed in patients with BMI than that without BMI; (iV) Patients with PET-BMI(+) in the intermediate risk-group should be managed as high-risk group patients.Table 1Cox regression analysis for PFS and OS for all the patients with DLBCL (N=169)PFSOSUnivariate analysisMultivariate analysisUnivariate analysisMultivariate analysisHR (95%CI)PHR (95%CI)PHR (95%CI)PHR (95%CI)PPET-BMI+3.96 (2.38-6.59)<0.001--6.73 (3.40-13.34)<0.0012.90 (1.21-6.96)0.017BMB-BMI+4.49 (2.53-7.98)<0.001--6.24 (3.06-12.73)<0.001--IPI>27.27 (4.19-12.63)<0.0013.12 (1.31-7.47)0.0109.02 (3.94-20.61)<0.0013.62 (1.01-13.03)0.049Age >601.61 (0.98-2.64)0.0601.18 (0.61-2.27)0.627Stage III or IV6.08 (2.77-13.36)<0.001--6.78 (2.08-22.12)0.002--ECOG 2-42.79 (1.65-4.71)<0.0011.97 (1.12-3.47)0.0193.39 (1.75-6.55)<0.001--LDH>ULN4.68 (2.82-7.78)<0.001--4.31 (1.96-9.48)<0.001--Extranodal site >13.15 (1.91-5.18)<0.001--3.04 (1.58-5.86)0.001-- [Display omitted] [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Quels sont les signes indirects de sepsis sévère en tomoscintigraphie par émission de positons au 18-désoxy-fluoroglucose ?

Introduction18F-fluorodeoxy-fluoroglucose (FDG) is generally actively trapped by infectious foci and thereby, the positron emission tomography (PET) imaging of FDG is increasingly used for detecting and localizing infectious foci. Indirect signs of infection were also described at FDG-PET but up to now, they were poorly analyzed and assessed. This study aimed to identify indirect signs of sepsis on the FDG-PET images from patients with severe sepsis and to assess their diagnostic values. Materials and methodsWe analyzed the FDG-PET images of 13 patients aged from 22 to 82 years and for whom a final diagnostic of severe sepsis could be achieved (7 pneumonia, 2 osteitis, 1 cervical cellulitis, 1 pyelonephritis, 1 abdominal parietal abscess, 1 abscess of an abdominal aortic stent-graft). All were mechanically ventilated and 7 had vasopressive drugs (septic shock). These FDG-PET images were compared to those from a group of control subjects matched for age and sex. Regions of interest were used to quantify the maximal standardised uptake value (SUVmax) within different tissues and organs. ResultsCompared to control-group, the sepsis-group exhibited higher SUVmax for bone marrow (3.73±1.14 versus 2.25±0.57, P<0.001), spleen (3.06±0.71 versus 2.15±0.46, P=0.001), adrenal glands (2.64±1.00 versus 1.77±0.35, P=0.016). At the opposite, SUVmax was lower in sepsis-group than in control-group for myocardium (3.44±1.20 versus 8.00±3.61, P=0.001). No significant difference was documented for liver, thyroid, skeletal muscles, arteries and blood. A cut-off of 2.6 for the SUVmax of bone marrow provided a sensitivity of 85% and a specificity of 92% for differentiating the septic patients from controls. ConclusionSeveral indirect signs of severe sepsis may be documented at FDG-PET: the hypermetabolisms of spleen and of bone marrow, which are conventional signs of infectious diseases, but also a myocardial hypometabolism and an adrenal hypermetabolism, which might rather relate to the severity of these diseases and to cardiovascular involvements.

18F-FDG PET/CT imaging findings of secondary hemophagocytic lymphohistiocytosis

Objective To summarize the imaging manifestations of 18F-FDG PET/CT in patients with secondary hemophagocytic lymphohistiocytosis (sHLH).Methods From January 2008 to June 2012,31 patients (18 males,13 females,average age:42 years) with sHLH were enrolled.All patients were divided into 3 groups:malignancy associated HLH (MAHLH) group (n =13),infection associated HLH (IAHLH) group (n =13) and rheumatosis associated HLH (RAHLH) group (n =5).They all underwent 18F-FDG PET/CT and SUVmax of lesions in each group was calculated.One-way analysis of variance and two-sample t test were used to analyze the SUVmax.Results Twenty-three patients were found splenomegaly with high FDG uptake,including 4 RAHLH patients,9 IAHLH patients and 10 MAHLH patients.The splenetic FDG uptake values (SUVmax) of RAHLH,IAHLH and MAHLH groups were 3.16±0.61,5.67±3.37 and 6.04±3.06,respectively (F=1.051,P＞0.05).The SUVmax of enlarged lymph nodes in IAHLH (n=8) and MAHLH groups (n =7) was 5.35± 1.69 and 10.14±5.24,respectively (t =-2.456,P＜0.05).Increased uptake in bone marrow was found in 17 patients,including 1 RAHLH patient,7 IAHLH patients and 9 MAHLH patients.The SUVmax of bone marrow in IAHLH and MAHLH patients was 5.31±2.05 and 6.36± 3.71 respectively (t=-0.670,P＞0.05).There were 10 cases of hepatomegaly,but only 4 of them had intense FDG uptake (SUVmax 4.9-10.2).The SUVmax of RAHLH,IAHLH and MAHLH groups was 3.02± 1.31,5.62±2.45 and 8.15±4.38,respectively (F=9.123,t=2.562,5.236,3.030,all P＜0.05).Conclusions RAHLH mostly showed splenomegaly with high FDG uptake,IAHLH and MAHLH both showed splenomegaly with lymph node and bone marrow invasion.The SUVmax of MAHLH was the highest.18F-FDG PET/CT imaging manifestations of sHLH may be helpful to improve the diagnostic accuracy. Key words: Lymphohistiocytosis, hemophagocytic ; Tomography, emission-computed; Tomography, X-ray computed ; Deoxyglucose

Diffuse increased splenic F-18 fluorodeoxyglucose uptake may be an indirect sign of acute pyogenic cause rather than tuberculous in patients with infectious spondylitis

The aim of this study was to investigate whether diffuse increased splenic fluorodeoxyglucose (FDG) uptake may be an indirect sign of an acute pyogenic cause of infectious spondylitis (IS). A retrospective review identified consecutive records of patients with IS who underwent F-18 FDG positron emission tomography-computed tomography scans between January 2007 and July 2008 and recruited 23 patients (57.8 ± 15.6 years, range: 20-81 years, eight men, 15 women) and their hematological laboratory data. The regions of interest were used to measure the maximum standardized uptake value (SUVmax) for the bone marrow (BM), liver, and spleen in each patient. We calculated the spleen/liver ratio (S/L ratio) by dividing the spleen SUVmax by liver SUVmax and the spleen/BM ratio (S/B ratio) by dividing spleen SUVmax by BM SUVmax as a parameter to assess the splenic FDG uptake. The acute pyogenic cause of the IS group showed statistically significantly higher values of spleen SUVmax (median, 1.71 vs. 1.16, P=0.0108), S/L ratio (median, 1.08 vs. 0.88, P=0.0454), and S/B ratio (median, 1.30 vs. 0.94, P=0.0055) than the chronic tuberculous cause of the IS. The optimal cut-off values for the quantitative indices were spleen SUVmax>1.49, S/B ratio>0.957, and S/L ratio>0.889. On the basis of the results presented, this study demonstrated that some quantitative indices from F-18 FDG positron emission tomography/computed tomography images could be indirect signs of an acute pyogenic cause of the IS. Among the various quantitative indices, spleen SUVmax, S/B ratio, and S/L ratio were potent indicators for an acute pyogenic cause of the IS.

Increased FDG bone marrow uptake after intracoronary progenitor cell therapy

Patients with coronary artery disease who undergo FDG, PET for therapy monitoring after intracoronary progenitor cell infusion (PCT) show an increased bone marrow uptake in some cases. AIM of the study was to evaluate the systemic bone marrow glucose metabolism in this patient group after PCT. FDG bone marrow uptake (BMU), measured as standardized uptake value (SUVmax) in the thoracic spine, was retrospectively evaluated in 23 control patients who did not receive PCT and in 75 patients who received PCT 3 +/- 2.2 days before PET scanning. Five out of them were pretreated with granulocyte colony-stimulating factor (G-CSF) 5 days prior to PCT and 10 +/- 1.2 days before PET scanning. In 39 patients who received only PCT without G-CSF and underwent PET therapy monitoring 4 months later, baseline and follow up bone marrow uptake were measured. Leucocytes, C-reactive protein (CRP) levels and the influence of nicotine consumption were compared with the BMU. In patients (n = 70) who received PCT without G-CSF, BMU median (1.3) was slightly, but significantly higher than in the controls (1.0) (p = 0.02) regardless nicotine consumption. BMU did not change significantly 4 months later (1.2) (p = 0.41, n.s.). After G-CSF pretreatment, patients showed a significantly higher bone marrow uptake (3.7) compared to patients only treated with PCT (1.3) (p = 0.023). Leucocyte blood levels were significantly higher in patients with a BMU > or =2.5 compared to patients with a bone marrow SUVmax <2.5 (p<0.001). CRP values did not correlate with the BMU (rho -0.02, p = 0.38). Monitoring PCT patients, a slightly increased FDG BMU may be observed which remains unchanged for several months. Unspecific bone marrow reactions after PCT may be associated with increased leucocyte blood levels and play a role in the changed systemic glucose BMU. In addition, pretreatment with G-CSF shows an intense amplification of BMU.