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¹⁸F-FLT PET in Hematologic Disorders: A Novel Technique to Analyze the Bone Marrow Compartment

¹ Department of Nuclear Medicine and Molecular Imaging, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands; and ² Department of Hematology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands

Correspondence: For correspondence contact: Pieter L. Jager, MD, PhD, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, P.O. Box 30,001, 9700 RB Groningen, The Netherlands. E-mail: p.l.jager{at}nucl.umcg.nl

Few diagnostic procedures are available to determine the degree of bone marrow cellularity and the numbers of cycling cells in patients with bone marrow disorders. Noninvasive imaging of the bone marrow compartment may be helpful. The PET tracer 3'-fluoro-3'-deoxy-L-thymidine (¹⁸F-FLT) has been developed recently. ¹⁸F-FLT uptake is related to the rate of DNA synthesis and increases with higher proliferation rates in many types of cancer. Background uptake of ¹⁸F-FLT in bone marrow is common. ¹⁸F-FLT PET might, therefore, visualize the high cycling activity of hematopoietic cells in the bone marrow compartment. Therefore, we investigated the feasibility of visualization and quantification of the activity of the bone marrow compartment with ¹⁸F-FLT PET to distinguish different hematologic disorders. Methods: Clinical and laboratory data of 18 patients with myelodysplasia (MDS), chronic myeloproliferative disorders, myelofibrosis, aplastic anemia, or multiple myeloma were correlated with the results of ¹⁸F-FLT PET using visual analysis and the standardized uptake value (SUV). Findings were compared with those of healthy control subjects (n = 14). Results: With SUV and visual analysis, a distinction could be made between MDS (n = 9), chronic myeloproliferative disorders (n = 3), and myelofibrosis (n = 3) compared with healthy control subjects. A significant increase in ¹⁸F-FLT uptake was observed in all of the studied patients with MDS and myeloproliferative disorders. In contrast, patients with myelofibrosis and aplastic anemia (n = 1) demonstrated a decline in bone marrow ¹⁸F-FLT uptake compared with healthy control subjects. Comparable results were observed in osteolytic lesions of patients with multiple myeloma (n = 2). Conclusion: ¹⁸F-FLT PET can be used to visualize the proliferative activity of the bone marrow compartment and may be helpful to distinguish separate hematologic disorders.

Key Words: bone marrow disorders • fluoro-L-thymidine • PET • myelodysplastic syndrome • proliferation

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