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OBJECTIVE@#Diffuse large B-cell lymphoma (DLBCL) is often associated with bone marrow infiltration, and 2-deoxy-2-(18F) fluorodeoxyglucose positron emission tomography/computed tomography ( 18F-FDG PET/CT) has potential diagnostic significance for bone marrow infiltration in DLBCL.@*METHODS@#A total of 102 patients diagnosed with DLBCL between September 2019 and August 2022 were included. Bone marrow biopsy and 18F-FDG PET/CT examinations were performed at the time of initial diagnosis. Kappa tests were used to evaluate the agreement of 18F-FDG PET/CT with the gold standard, and the imaging features of DLBCL bone marrow infiltration on PET/CT were described.@*RESULTS@#The total detection rate of bone marrow infiltration was not significantly different between PET/CT and primary bone marrow biopsy ( P = 0.302) or between the two bone marrow biopsies ( P = 0.826). The sensitivity, specificity, and Youden index of PET/CT for the diagnosis of DLBCL bone marrow infiltration were 0.923 (95% CI, 0.759-0.979), 0.934 (95% CI, 0.855-0.972), and 0.857, respectively.@*CONCLUSION@#18F-FDG PET/CT has a comparable efficiency in the diagnosis of DLBCL bone marrow infiltration. PET/CT-guided bone marrow biopsy can reduce the misdiagnosis of DLBCL bone marrow infiltration.
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Humans , Positron Emission Tomography Computed Tomography/methods , Fluorodeoxyglucose F18 , Bone Marrow/pathology , Retrospective Studies , Positron-Emission Tomography/methods , Lymphoma, Large B-Cell, Diffuse/pathologyABSTRACT
ABSTRACT Background: Bone marrow evaluation (BME) is crucial for establishing an accurate staging and prognosis in lymphoma patients. Objective: The objective of the study was to study the diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) against bone marrow biopsy (BMB) for BME. Methods: Five hundred patient files of newly diagnosed lymphoma patients treated at an academic medical center were reviewed for BME at diagnosis by BMB and FDG PET-CT. Diagnostic performance of FDG PET-CT for detecting bone marrow infiltration (BMI) was assessed, as well as clinical predictors for positive BMB and positive FDG PET-CT. Results: BMB was positive in 16.3% of all patients, and 28.7% had a positive FDG PET-CT for BMI. Overall, the sensitivity of FDG PET-CT was 74.1% and specificity 80.1%. As for predictors for BMB and FDG PET-CT positivity, B symptoms and thrombocytopenia were independent factors for BMI. Seventy-four patients had discordant results between BMB and FDG PET-CT, non-Hodgkin lymphoma (NHL) having the most significant discordance. This discrepancy did not affect treatment. Conclusions: FDG PET-CT shows excellent performance for the detection of BMI in Hodgkin lymphoma. For diffuse large B-cell lymphoma, we recommend performing BMB and FDG PET-CT as complementary tests. In all other NHL, a unilateral BMB is mandatory at diagnosis.
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Background and purpose:Positron emission tomography-computed tomography (PET/CT) is playing an increasingly important role in the diagnosis, therapy and follow-up of lymphoma patients. This study aimed to explore clinical and pathological features and bone marrow infiltration status in lymphoma patients with diffused high bone marrow glucose uptake on18F-FDG PET/CT.Methods:It was a retrospective study. Bone marrow infiltration status, pathological and clinical data from 62 cases of pathologically diagnosed lymphoma and diffused high bone marrow glucose uptake were analyzed.Results:Distribution of histopathological subtype in those cases was in accordance with that in previously reported Chinese lymphoma patients. Significant difference was demonstrated in standard uptake value (SUV) between pa-tients with aggressive and indolent histopathological subtypes (8.43vs 5.38,P=0.048), patients with and without B symp-toms (8.30vs 5.72,P=0.033), and patients with and without bone marrow infiltration (8.78vs 6.96,P=0.020). 32 patients were diagnosed as “bone marrow infiltration” by bone marrow biopsy. There was significant difference in histopathologi-cal subtype distribution between patients with and without bone marrow infiltration (P=0.001). In patients with bone marrow infiltration, there were higher proportions of mantle cell lymphoma, nodal marginal zone B cell lymphoma, Burkitt’s lym-phoma and anaplastic large cell lymphoma. In contrast, patients without bone marrow infiltration suffered more from diffuse large B-cell lymphoma, peripheral T cell lymphoma, enteropathic T cell lymphoma and extranodal NK/T-cell lymphoma (nasal type). False positive results in bone marrow glucose uptake may be caused by fever or anemia.Conclusion:Diffused high bone marrow glucose uptake on18F-FDG PET/CT should be evaluated in combination with the uptake values, clinical features and histological subtypes, to minimize the misdiagnosis and to better guide staging and therapy of lymphoma.
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As one of the most common hematologic malignancy,bone marrow involvement in lymphoma has diagnosis and therapeutic implications,especially in early chemotherapy curative effect evaluation.At present,the diagnosis of bone marrow involvement was mainly depend on bone marrow biopsy,but it has poor sensitivity suffered from sampling errors resulting in delayed treatment.Recently,with the development and perfect of imaging technology,the new means of detection with higher sensitivity and specificity are applied to diagnosis of bone marrow involvement.In this article,the application of imaging,magnetic resonance imaging (MRI) and 18F-FDG PET-CT in this area is reviewed.
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Thrombocytopenia is a common clinical problem with many etiological causes. Although transient bone marrow suppression and marrow infiltration by malignancies are important causes, certain non-malignant conditions such as nutritional causes and infections are equally important as the treatment is simple and cure is possible. Depending on the aetiology, the clinical presentation may vary. Knowing the exact aetiology is important for specific treatment and prognostication. A total of 303 cases of thrombocytopenia were studied out of which males were 44% and females were 56%. The patients’ age ranged from 5 months to 84 yrs. The commonest presenting symptom was fever with bleeding manifestations and jaundice. 14% of cases are of Grade 1, 20% of the cases of Grade 2, 5% of cases of Grade 3 and 31% of cases had counts less than 25000/cu.mm i.e. of Grade 4. 50% of cases in Grade 4 had a decreased number of megakaryocytes in the bone marrow. The most common cause of thrombocytopenia in our study was megaloblastic anaemia (48.6%), ITP (20%), post-viral (10.9%) followed by leukaemia, aplastic anaemia and others. Thrombocytopenia has a spectrum of causes which can be diagnosed by detailed history and peripheral smear examination supported by bone marrow examination. Megaloblastic anaemia was the commonest cause of thrombocytopenia followed by immune thrombocytopenia. Unlike in the western India megaloblastic anemia is highly prevalent and is the leading correctable cause of thrombocytopenia. Most of the patients with Grade 4 thrombocytopenia had a decreased number of megakaryocytes in the bone marrow suggesting a production defect.
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Objective To evaluate the value of MRI in qualitative and quantitative diagnosis of bone marrow involvement in patients with lymphoma. Methods 28 diagnosed lymphoma with bone marrow infiltration and 31 healthy spines as controls were included.MRI performance and the signal intensity ratio on T1WI (SIR1) of the spine bone marrow and cerebrospinal fluid were analyzed and statistical analyses were performed.Results Qualitative diagnosis among these patients,was shown than MRI results indicated that 27 cases had abnormal signal. The sensitivity of MRI was 96.4 ％. There were four main patterns of marrow infiltration in MRI,containing nodular pattern 21.4 ％ (6/28),scattered pattern 53.6 ％ (15/28),mottled pattern 14.3 ％ (4/28) and uniform pattern 7.1％ (2/28) respectively.By quantitative diagnosis the SIR1 of study group (1.251±0.253) was apparently lower than that in the control group (2.625±0.434) with statistical significance (t =15.022,P ＜ 0.001).The results of multiple comparisons showed that the SIR1 of mild degree (1.390±0.172),moderate degree (0.982±0.790) and severe degree (0.908±0.122) patients with lymphoma compared with the normal controls had significant differences (all P =0.000),and difference between mild and moderate degree had statistical significance (LSD,P =0.012),so did the difference between mild and severe degree (LSD,P =0.025).However,no significant difference could be seen between moderate and severe degree (LSD, P =0.757). Positive linear correlation was existed between the persentages of SIR1 and tumor cells in bone marrow (r =-0.765, P ＜ 0.001). Conclusion As a noninvasive and direct-viewing technique, MRI presents a global view of bone marrow with high sensitivity in detecting bone marrow involvement in lymphoma. To a certain extent, it could be possible to estimate the infiltration degree and evaluation of the tumor burden in bone marrow by quantitative measurement of MRI.
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Objective To detect serum CA125 and VEGF in patients of non-Hodgkin lymophoma (NHL) involved in bone marrow and analyse prognostic criteria for NHL. Methods The clinical data of 97 patient were chosen as research objects. They were all first-visit patients. Bone marrow infiltrated with lymphoma cell leukemia of 50 patients were identified by bone marrow aspiration or bone marrow biopsy 46 cases of normal bone marrow were used as controls. The serum CA125 and VEGF were detected by ELISA before treatment. Results Among 97 cases of non-Hodgkin disease, there were 50 cases of bone marrow infiltrated lymphoma cells with a incidence rate of 51.5 %. CA125 and VEGF level in the patients whose bone marrow or lymphoma cell leukemia existed NHL cells was much higher than that of NHL with negative bone marrow infutration (P <0.05). Conclusion CA125 and VEGF can be concluded clinical markers which decide bone marrow or lymphoma cell leukem of the NHL patients whether existed NHL cells or not.