The Clinical Utility of FDG PET-CT in Evaluation of Bone Marrow Involvement by Lymphoma

Purpose

Bone marrow biopsy is a standard method for the evaluation of bone marrow infiltration by

lymphoma; however, it is an invasive and painful procedure. Fluorodeoxyglucose positron

emission tomography–computed tomography (FDG PET-CT) is a noninvasive imaging technique

with the potential to detect bone marrow involvement by lymphoma.

Materials and Methods

We retrospectively reviewed medical records of lymphoma patients. All patients were

examined by FDG PET-CT and iliac crest bone marrow biopsy for initial staging work-up.

Results

The study population comprised 94 patients (median age, 60 years; 56 males) with

Hodgkin’s lymphoma (n=8) or non-Hodgkin’s lymphoma (n=86). Maximum standardized

uptake values on the iliac crest of patients with lymphoma infiltrated bone marrow were

significantly higher than those of patients with intact bone marrow (2.2±1.2 g/mL vs.

1.3±0.4 g/mL; p=0.001). The calculated values for FDG PET-CT during evaluation of bone

marrow involvement were as follows: sensitivity 50%, specificity 96%, positive predictive

value 80%, negative predictive value 85%, and positive likelihood ratio (LR+) 11.7. The

value of LR+ was 16.0 in patients with aggressive subtypes of non-Hodgkin’s lymphoma

(NHL).

Conclusion

FDG PET-CT could not replace bone marrow biopsy due to the low sensitivity of FDG PET-CT

for detection of bone marrow infiltration in lymphoma patients. Conversely, FDG PET-CT had

high specificity and LR+; therefore, it could be a useful tool for image-guided biopsy for

lymphoma staging, especially for aggressive subtypes of NHL. In addition, unilateral bone

marrow biopsy could be substituted for bilateral bone marrow biopsy in lymphoma patients

with increased FDG uptake on any iliac crest.