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Erschienen in: Annals of Nuclear Medicine 7/2009

01.09.2009 | Original Article

A bone marrow F-18 FDG uptake exceeding the liver uptake may indicate bone marrow hyperactivity

verfasst von: Kentaro Inoue, Ryoi Goto, Ken Okada, Shigeo Kinomura, Hiroshi Fukuda

Erschienen in: Annals of Nuclear Medicine | Ausgabe 7/2009

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Abstract

Objective

In clinical positron emission tomography (PET) studies for oncology, it is occasionally required to differentiate a diffuse increase in bone marrow (BM) F-18 fluoro-2-deoxyglucose (FDG) uptake due to the involvement of malignancy or hematopoietic disease and that due to the administration of hematopoietic cytokines, an inflammation reaction, or stimulation by some types of malignancy. The objectives of this study were to clarify the relationships between BM F-18 FDG uptake and blood parameters as well as age, and also to determine the degree of F-18 FDG accumulation that constitutes an abnormal level referring to blood parameters.

Methods

Records of 65 patients, 32 with benign diseases and 33 with malignancies without metastasis in bone and liver until a half year after the PET examination, were analyzed retrospectively. Regions of interest were placed on the liver and the lower thoracic and lumbar vertebrae to measure the standardized uptake value (SUV), and vertebral SUVs were averaged as the BM SUVmean. The BM SUVmean was divided by the liver SUV to calculate the BM/liver ratio. The relationships among the BM SUVmean, or BM/liver ratio, and blood parameters and age were tested using multiple regression analysis.

Results

In both patients with and without malignancy, a multiple regression model using the BM/liver ratio showed a higher coefficient of determination value than that using the BM SUVmean, indicating that the correction by the liver SUV reduced the interindividual variation in the BM SUVmean. The BM/liver ratio was negatively correlated with age (β = −0.41 and −0.43, respectively) and positively correlated with serum C-reactive protein (CRP) level (β = 0.39 and 0.46, respectively) in both groups of patients. Every patient with benign disease who had a ratio greater than or equal to 1 had an increased CRP level.

Conclusions

The BM F-18 FDG uptake depends on the patient’s age and serum CRP level, both with and without malignancy. A BM F-18 FDG uptake greater than or equal to that of the liver may indicate BM activation.
Literatur
1.
Zurück zum Zitat Gordon BA, Flanagan FL, Dehdashti F. Whole-body positron emission tomography: normal variations, pitfalls, and technical considerations. AJR Am J Roentgenol. 1997;169:1675–80.PubMed Gordon BA, Flanagan FL, Dehdashti F. Whole-body positron emission tomography: normal variations, pitfalls, and technical considerations. AJR Am J Roentgenol. 1997;169:1675–80.PubMed
2.
Zurück zum Zitat Prevost S, Boucher L, Larivee P, Boileau R, Benard F. Bone marrow hypermetabolism on 18F-FDG PET as a survival prognostic factor in non-small cell lung cancer. J Nucl Med. 2006;47:559–65.PubMed Prevost S, Boucher L, Larivee P, Boileau R, Benard F. Bone marrow hypermetabolism on 18F-FDG PET as a survival prognostic factor in non-small cell lung cancer. J Nucl Med. 2006;47:559–65.PubMed
3.
Zurück zum Zitat Cicone F, Loose D, Deron P, Vermeersch H, Signore A, Van de Vyvere F, et al. Prognostic value of FDG uptake by the bone marrow in squamous cell carcinoma of the head and neck. Nucl Med Commun. 2008;29:431–5.PubMedCrossRef Cicone F, Loose D, Deron P, Vermeersch H, Signore A, Van de Vyvere F, et al. Prognostic value of FDG uptake by the bone marrow in squamous cell carcinoma of the head and neck. Nucl Med Commun. 2008;29:431–5.PubMedCrossRef
4.
Zurück zum Zitat Van de Wiele C, VandeVyver F, Debruyne C, Philippe J, van Meerbeeck JP. FDG uptake by the bone marrow in NSCLC patients is related to TGF-beta but not to VEGF or G-CSF serum levels. Eur J Nucl Med Mol Imaging. 2008;35:519–22.PubMedCrossRef Van de Wiele C, VandeVyver F, Debruyne C, Philippe J, van Meerbeeck JP. FDG uptake by the bone marrow in NSCLC patients is related to TGF-beta but not to VEGF or G-CSF serum levels. Eur J Nucl Med Mol Imaging. 2008;35:519–22.PubMedCrossRef
5.
Zurück zum Zitat Fan C, Hernandez-Pampaloni M, Houseni M, Chamroonrat W, Basu S, Kumar R, et al. Age-related changes in the metabolic activity and distribution of the red marrow as demonstrated by 2-deoxy-2-[F-18]fluoro-D-glucose positron emission tomography. Mol Imaging Biol. 2007;9:300–7.PubMedCrossRef Fan C, Hernandez-Pampaloni M, Houseni M, Chamroonrat W, Basu S, Kumar R, et al. Age-related changes in the metabolic activity and distribution of the red marrow as demonstrated by 2-deoxy-2-[F-18]fluoro-D-glucose positron emission tomography. Mol Imaging Biol. 2007;9:300–7.PubMedCrossRef
6.
Zurück zum Zitat Murata Y, Kubota K, Yukihiro M, Ito K, Watanabe H, Shibuya H. Correlations between 18F-FDG uptake by bone marrow and hematological parameters: measurements by PET/CT. Nucl Med Biol. 2006;33:999–1004.PubMedCrossRef Murata Y, Kubota K, Yukihiro M, Ito K, Watanabe H, Shibuya H. Correlations between 18F-FDG uptake by bone marrow and hematological parameters: measurements by PET/CT. Nucl Med Biol. 2006;33:999–1004.PubMedCrossRef
7.
Zurück zum Zitat Ramos CD, Erdi YE, Gonen M, Riedel E, Yeung HW, Macapinlac HA, et al. FDG-PET standardized uptake values in normal anatomical structures using iterative reconstruction segmented attenuation correction and filtered back-projection. Eur J Nucl Med. 2001;28:155–64.PubMedCrossRef Ramos CD, Erdi YE, Gonen M, Riedel E, Yeung HW, Macapinlac HA, et al. FDG-PET standardized uptake values in normal anatomical structures using iterative reconstruction segmented attenuation correction and filtered back-projection. Eur J Nucl Med. 2001;28:155–64.PubMedCrossRef
8.
Zurück zum Zitat Sugawara Y, Fisher SJ, Zasadny KR, Kison PV, Baker LH, Wahl RL. Preclinical and clinical studies of bone marrow uptake of fluorine-1-fluorodeoxyglucose with or without granulocyte colony-stimulating factor during chemotherapy. J Clin Oncol. 1998;16:173–80.PubMed Sugawara Y, Fisher SJ, Zasadny KR, Kison PV, Baker LH, Wahl RL. Preclinical and clinical studies of bone marrow uptake of fluorine-1-fluorodeoxyglucose with or without granulocyte colony-stimulating factor during chemotherapy. J Clin Oncol. 1998;16:173–80.PubMed
9.
Zurück zum Zitat Thie JA. Understanding the standardized uptake value, its methods, and implications for usage. J Nucl Med. 2004;45:1431–4.PubMed Thie JA. Understanding the standardized uptake value, its methods, and implications for usage. J Nucl Med. 2004;45:1431–4.PubMed
10.
Zurück zum Zitat Iozzo P, Geisler F, Oikonen V, Maki M, Takala T, Solin O, et al. Insulin stimulates liver glucose uptake in humans: an 18F-FDG PET Study. J Nucl Med. 2003;44:682–9.PubMed Iozzo P, Geisler F, Oikonen V, Maki M, Takala T, Solin O, et al. Insulin stimulates liver glucose uptake in humans: an 18F-FDG PET Study. J Nucl Med. 2003;44:682–9.PubMed
11.
Zurück zum Zitat Chin BB, Green ED, Turkington TG, Hawk TC, Coleman RE. Increasing uptake time in FDG-PET: standardized uptake values in normal tissues at 1 versus 3 h. Mol Imaging Biol. 2009; 11(2):118–22 Chin BB, Green ED, Turkington TG, Hawk TC, Coleman RE. Increasing uptake time in FDG-PET: standardized uptake values in normal tissues at 1 versus 3 h. Mol Imaging Biol. 2009; 11(2):118–22
12.
Zurück zum Zitat Ricci C, Cova M, Kang YS, Yang A, Rahmouni A, Scott WW Jr, et al. Normal age-related patterns of cellular and fatty bone marrow distribution in the axial skeleton: MR imaging study. Radiology. 1990;177:83–8.PubMed Ricci C, Cova M, Kang YS, Yang A, Rahmouni A, Scott WW Jr, et al. Normal age-related patterns of cellular and fatty bone marrow distribution in the axial skeleton: MR imaging study. Radiology. 1990;177:83–8.PubMed
13.
Zurück zum Zitat Blodgett TM, Ames JT, Torok FS, McCook BM, Meltzer CC. Diffuse bone marrow uptake on whole-body F-18 fluorodeoxyglucose positron emission tomography in a patient taking recombinant erythropoietin. Clin Nucl Med. 2004;29:161–3.PubMedCrossRef Blodgett TM, Ames JT, Torok FS, McCook BM, Meltzer CC. Diffuse bone marrow uptake on whole-body F-18 fluorodeoxyglucose positron emission tomography in a patient taking recombinant erythropoietin. Clin Nucl Med. 2004;29:161–3.PubMedCrossRef
14.
Zurück zum Zitat Plantade A, Montravers F, Selle F, Izrael V, Talbot JN. Diffusely increased F-18 FDG uptake in bone marrow in a patient with acute anemia and recent erythropoietin therapy. Clin Nucl Med. 2003;28:771–2.PubMedCrossRef Plantade A, Montravers F, Selle F, Izrael V, Talbot JN. Diffusely increased F-18 FDG uptake in bone marrow in a patient with acute anemia and recent erythropoietin therapy. Clin Nucl Med. 2003;28:771–2.PubMedCrossRef
15.
Zurück zum Zitat Kao PC, Shiesh SC, Wu TJ. Serum C-reactive protein as a marker for wellness assessment. Ann Clin Lab Sci. 2006;36:163–9.PubMed Kao PC, Shiesh SC, Wu TJ. Serum C-reactive protein as a marker for wellness assessment. Ann Clin Lab Sci. 2006;36:163–9.PubMed
16.
Zurück zum Zitat Yamada S, Gotoh T, Nakashima Y, Kayaba K, Ishikawa S, Nago N, et al. Distribution of serum C-reactive protein and its association with atherosclerotic risk factors in a Japanese population : Jichi Medical School Cohort Study. Am J Epidemiol. 2001;153:1183–90.PubMedCrossRef Yamada S, Gotoh T, Nakashima Y, Kayaba K, Ishikawa S, Nago N, et al. Distribution of serum C-reactive protein and its association with atherosclerotic risk factors in a Japanese population : Jichi Medical School Cohort Study. Am J Epidemiol. 2001;153:1183–90.PubMedCrossRef
17.
Zurück zum Zitat Mauer AM, Athens JW, Ashenbrucker H, Cartwright GE, Wintrobe MM. Leukokinetic studies. II. A method for labeling granulocytes in vitro with radioactive diisopropylfluorophosphate (DFP). J Clin Invest. 1960;39:1481–6.PubMedCrossRef Mauer AM, Athens JW, Ashenbrucker H, Cartwright GE, Wintrobe MM. Leukokinetic studies. II. A method for labeling granulocytes in vitro with radioactive diisopropylfluorophosphate (DFP). J Clin Invest. 1960;39:1481–6.PubMedCrossRef
18.
Zurück zum Zitat Vigushin DM, Pepys MB, Hawkins PN. Metabolic and scintigraphic studies of radioiodinated human C-reactive protein in health and disease. J Clin Invest. 1993;91:1351–7.PubMedCrossRef Vigushin DM, Pepys MB, Hawkins PN. Metabolic and scintigraphic studies of radioiodinated human C-reactive protein in health and disease. J Clin Invest. 1993;91:1351–7.PubMedCrossRef
19.
Zurück zum Zitat Chiang SB, Rebenstock A, Guan L, Alavi A, Zhuang H. Diffuse bone marrow involvement of Hodgkin lymphoma mimics hematopoietic cytokine-mediated FDG uptake on FDG PET imaging. Clin Nucl Med. 2003;28:674–6.PubMedCrossRef Chiang SB, Rebenstock A, Guan L, Alavi A, Zhuang H. Diffuse bone marrow involvement of Hodgkin lymphoma mimics hematopoietic cytokine-mediated FDG uptake on FDG PET imaging. Clin Nucl Med. 2003;28:674–6.PubMedCrossRef
20.
Zurück zum Zitat Lewanski CR, Kaplan GR, Potter J, Richman P, Ashford RF, Wong WL. Bone marrow involvement in breast cancer detected by positron emission tomography. J R Soc Med. 1999;92:193–5.PubMed Lewanski CR, Kaplan GR, Potter J, Richman P, Ashford RF, Wong WL. Bone marrow involvement in breast cancer detected by positron emission tomography. J R Soc Med. 1999;92:193–5.PubMed
21.
Zurück zum Zitat Seshadri N, Wright P, Balan KK. Rhabdomyosarcoma with widespread bone marrow infiltration: beneficial management role of F-18 FDG PET. Clin Nucl Med. 2007;32:787–9.PubMedCrossRef Seshadri N, Wright P, Balan KK. Rhabdomyosarcoma with widespread bone marrow infiltration: beneficial management role of F-18 FDG PET. Clin Nucl Med. 2007;32:787–9.PubMedCrossRef
22.
Zurück zum Zitat Hollinger EF, Alibazoglu H, Ali A, Green A, Lamonica G. Hematopoietic cytokine-mediated FDG uptake simulates the appearance of diffuse metastatic disease on whole-body PET imaging. Clin Nucl Med. 1998;23:93–8.PubMedCrossRef Hollinger EF, Alibazoglu H, Ali A, Green A, Lamonica G. Hematopoietic cytokine-mediated FDG uptake simulates the appearance of diffuse metastatic disease on whole-body PET imaging. Clin Nucl Med. 1998;23:93–8.PubMedCrossRef
23.
Zurück zum Zitat Yao WJ, Hoh CK, Hawkins RA, Glaspy JA, Weil JA, Lee SJ, et al. Quantitative PET imaging of bone marrow glucose metabolic response to hematopoietic cytokines. J Nucl Med. 1995;36:794–9.PubMed Yao WJ, Hoh CK, Hawkins RA, Glaspy JA, Weil JA, Lee SJ, et al. Quantitative PET imaging of bone marrow glucose metabolic response to hematopoietic cytokines. J Nucl Med. 1995;36:794–9.PubMed
24.
Zurück zum Zitat Morooka M, Kubota K, Murata Y, Shibuya H, Ito K, Mochizuki M, et al. (18)F-FDG-PET/CT findings of granulocyte colony-stimulating factor (G-CSF)-producing lung tumors. Ann Nucl Med. 2008;22:635–9.PubMedCrossRef Morooka M, Kubota K, Murata Y, Shibuya H, Ito K, Mochizuki M, et al. (18)F-FDG-PET/CT findings of granulocyte colony-stimulating factor (G-CSF)-producing lung tumors. Ann Nucl Med. 2008;22:635–9.PubMedCrossRef
25.
Zurück zum Zitat Takahashi S, Kuwabara K, Sawafuji M, Akiduki S, Ishizaka A. F-18 FDG PET imaging in a patient with granulocyte colony-stimulating factor producing pulmonary pleomorphic carcinoma. Clin Nucl Med. 2008;33:555–7.PubMedCrossRef Takahashi S, Kuwabara K, Sawafuji M, Akiduki S, Ishizaka A. F-18 FDG PET imaging in a patient with granulocyte colony-stimulating factor producing pulmonary pleomorphic carcinoma. Clin Nucl Med. 2008;33:555–7.PubMedCrossRef
26.
Zurück zum Zitat Elstrom RL, Tsai DE, Vergilio JA, Downs LH, Alavi A, Schuster SJ. Enhanced marrow [18F]fluorodeoxyglucose uptake related to myeloid hyperplasia in Hodgkin’s lymphoma can simulate lymphoma involvement in marrow. Clin Lymphoma. 2004;5:62–4.PubMedCrossRef Elstrom RL, Tsai DE, Vergilio JA, Downs LH, Alavi A, Schuster SJ. Enhanced marrow [18F]fluorodeoxyglucose uptake related to myeloid hyperplasia in Hodgkin’s lymphoma can simulate lymphoma involvement in marrow. Clin Lymphoma. 2004;5:62–4.PubMedCrossRef
27.
28.
Zurück zum Zitat Inoue K, Okada K, Harigae H, Taki Y, Goto R, Kinomura S, et al. Diffuse bone marrow uptake on F-18 FDG PET in patients with myelodysplastic syndromes. Clin Nucl Med. 2006;31:721–3.PubMedCrossRef Inoue K, Okada K, Harigae H, Taki Y, Goto R, Kinomura S, et al. Diffuse bone marrow uptake on F-18 FDG PET in patients with myelodysplastic syndromes. Clin Nucl Med. 2006;31:721–3.PubMedCrossRef
29.
Zurück zum Zitat Takalkar A, Yu JQ, Kumar R, Xiu Y, Alavi A, Zhuang H. Diffuse bone marrow accumulation of FDG in a patient with chronic myeloid leukemia mimics hematopoietic cytokine-mediated FDG uptake on positron emission tomography. Clin Nucl Med. 2004;29:637–9.PubMedCrossRef Takalkar A, Yu JQ, Kumar R, Xiu Y, Alavi A, Zhuang H. Diffuse bone marrow accumulation of FDG in a patient with chronic myeloid leukemia mimics hematopoietic cytokine-mediated FDG uptake on positron emission tomography. Clin Nucl Med. 2004;29:637–9.PubMedCrossRef
Metadaten
Titel
A bone marrow F-18 FDG uptake exceeding the liver uptake may indicate bone marrow hyperactivity
verfasst von
Kentaro Inoue
Ryoi Goto
Ken Okada
Shigeo Kinomura
Hiroshi Fukuda
Publikationsdatum
01.09.2009
Verlag
Springer Japan
Erschienen in
Annals of Nuclear Medicine / Ausgabe 7/2009
Print ISSN: 0914-7187
Elektronische ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-009-0286-9

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