Assessment of diffuse bone marrow involvement on 18F-fluoro-D-glucose PET/computed tomography

Purpose

This study aims to investigate the role of bone marrow (BM) FDG uptake distribution in assessing pathological status of BM with diffusely increased FDG uptake.

Methods

We retrospectively analyzed one hundred and thirty-four PET/CT scans with diffusely hypermetabolic BM, which involved forty-nine patients with BM malignant infiltration (BMI) and eighty-five patients with benign BM disorders. The maximum standardized uptake values (SUVmax) of axial skeletons, appendicular skeletons, and the range of humerus FDG uptake were measured. The clinical and laboratory data were collected. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve were used to evaluate the risk factors for BMI and discriminative ability of above indicators for the pathology status of BM.

Results

In patients with diffusely hypermetabolic BM, both the glucose metabolism of axial and appendicular skeletons was higher in BMI than BM benign disorders. The multivariate logistic regression analysis (stepwise) revealed age (odds ratio [OR] 1.073; 95%CI, 1.031–1.117; P = 0.001), femurs SUVmax (OR 2.058; 95%CI, 1.317–3.218; P = 0.002), neutrophil count (OR 0.805; 95%CI, 0.718–0.902; P < 0.001) and range of humerus FDG uptake (OR 11.335; 95%CI, 2.831–45.377; P = 0.001) were associated with BMI. Combined diagnosis had the highest ROC value (AUC 0.918; 95%CI, 0.864–0.973; P < 0.001) with a sensitivity of 89.8% and specificity of 85.9%.

Conclusion

The BM activity of the appendicular skeleton was more significant in distinguishing BM malignant and benign disorders. Range of humerus FDG uptake combined femurs SUVmax, neutrophil count and age was reliable for assessing diffuse BM involvement.