Alam Mohammed Shah, Fu Lilan, Ren Yun-Yan, Wu Hu-Bing, Wang Quan-Shi, Han Yan-Jiang, Zhou Wen-Lan, Li Hong-Sheng, Wang Zhen
NanFang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Medicine (Baltimore). 2016 Dec;95(52):e5579. doi: 10.1097/MD.0000000000005579.
The present study was performed to investigate whether the markedly 2-deoxy-2-(fluorine-18) fluoro-D-glucose (F-FDG) uptake in the bone marrow (BM) is a presentation of malignant infiltration (MI).Super bone marrow uptake (super BMU) was used to name the markedly F-FDG uptake on BM, which was similar to or higher than that of the brain. From April 2008 to December 2015, 31 patients with such presentation were retrospectively reviewed. The F-FDG uptake was semiquantified using SUVmax and BM to cerebellum (BM/C) ratio. The origin of super BMU was diagnosed by pathology. Some blood parameters, as well as fever, were also collected and analyzed. For comparison, 106 patients with mildly and moderately uptake in BM and 20 healthy subjects were selected as the control group.Bone marrow MI was diagnosed in 93.5% (29/31) patients with super BMU, which mostly originated from acute leukemia and highly aggressive lymphoma. The super BMU group had markedly higher F-FDG uptake in the BM than those of mildly and moderately uptake, and the control subjects (all P = 0.000) and the BM/C ratio reached a high of 1.24 ± 0.36. The incidence of bone marrow MI in the super BMU group was markedly higher than that of mildly and moderately uptake (93.5% vs 36.8%, P = 0.000). Based on the receiver operating characteristic analysis, when cut-off values of BM/C and SUVmax were set at 0.835 and 6.560, the diagnostic specificity for bone marrow MI reached the high levels of 91.4% and 95.7%, respectively. In 15 patients with bone marrow MI, the extra-BM malignant lesions were simultaneously detected by F-FDG PET/CT. The liver and the nasal cavity involvements were only found in the patients with lymphoma, but not in those with leukemia. A decrease of leukocyte, hemoglobin, and platelet counts was noted in 48.4%, 86.2%, and 51.5% of patients with bone marrow MI, respectively.The present study revealed that super BMU was a highly potent indicator for the bone marrow MI.
本研究旨在调查骨髓中明显的2-脱氧-2-（氟-18）氟-D-葡萄糖（F-FDG）摄取是否为恶性浸润（MI）的表现。骨髓中明显的F-FDG摄取被称为超骨髓摄取（super BMU），其与脑摄取相似或高于脑摄取。回顾性分析了2008年4月至2015年12月期间有此表现的31例患者。使用SUVmax和骨髓与小脑（BM/C）比值对F-FDG摄取进行半定量分析。通过病理诊断超BMU的起源。还收集并分析了一些血液参数以及发热情况。为作比较，选择106例骨髓摄取轻度和中度的患者以及20名健康受试者作为对照组。93.5%（29/31）的超BMU患者被诊断为骨髓MI，其大多起源于急性白血病和高度侵袭性淋巴瘤。超BMU组骨髓中的F-FDG摄取明显高于轻度和中度摄取组以及对照组（所有P = 0.000），且BM/C比值高达1.24±0.36。超BMU组骨髓MI的发生率明显高于轻度和中度摄取组（93.5%对36.8%，P = 0.000）。基于受试者工作特征分析，当BM/C和SUVmax的截断值分别设定为0.835和6.560时，骨髓MI的诊断特异性分别达到91.4%和95.7%的高水平。在15例骨髓MI患者中，F-FDG PET/CT同时检测到骨髓外恶性病变。肝脏和鼻腔受累仅在淋巴瘤患者中发现，而在白血病患者中未发现。骨髓MI患者中分别有48.4%、86.
