Role of F-18 FDG PET/CT in assessing bone marrow involvement in pediatric Hodgkin's lymphoma

Kanhaiyalal Agrawal, Bhagwant Rai Mittal, Deepak Bansal, Neelam Varma, Radhika Srinivasan, Amita Trehan, Kuruva Manohar, Raghava Kashyap, Anish Bhattacharya, Ram K Marwaha
Annals of Nuclear Medicine 2013, 27 (2): 146-51

OBJECTIVES: The aim of the current study was to assess the utility of F-18-fluoro-2-deoxy-D-glucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) in assessing bone marrow involvement (BMI) compared to bone marrow biopsy (BMB) in initial staging of Hodgkin's lymphoma (HL) in pediatric patients.

METHODS: Data of 38 pediatric patients (mean age 9.8 years, range 3-18 years) with HL were analyzed for the involvement of bone marrow. All patients underwent non-contrast F-18 FDG PET/CT study. BMB was done in 31 patients from the bilateral iliac crests. Scans were interpreted by two nuclear medicine physicians blinded to the details of BMB.

RESULTS: Of the 31 patients who underwent BMB, 5 patients had lymphomatous involvement on BMB. PET/CT was positive in four of these five patients. In 26 patients negative on BMB, PET was negative in 23 patients and positive in 3 patients for BMI. The sensitivity and negative predictive value of F-18 FDG PET/CT was 87.5 and 96%, respectively, for BMI.

CONCLUSIONS: F-18 FDG PET/CT can predict BMB results with high accuracy. F-18 FDG PET/CT may be used at initial staging of pediatric Hodgkin's lymphoma as it uncovers unsuspected BMI and BMB may be omitted in patients with PET-positive BMI.

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