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Bone Marrow Hypermetabolism on 18F-FDG PET as a Survival Prognostic Factor in Non–Small Cell Lung Cancer

Sylvain Prévost, MD1, Luc Boucher, MD2, Pierre Larivée, MD3, Robert Boileau, MD3 and François Bénard, MD1

1 Metabolic and Functional Imaging Centre, Clinical Research Centre, Centre Hospitalier Universitaire de Sherbrooke, Fleurimont, Quebec, Canada; 2 Department of Nuclear Medicine, Centre Hospitalier Universitaire de Montréal, Montréal, Quebec, Canada; and 3 Division of Pneumology, Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke, Fleurimont, Quebec, Canada


Figure 1
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  		FIGURE 1.  Coronal, sagittal, and transaxial slices (left to right) through bone marrow of a patient with NSCLC showing markedly increased bone marrow metabolism on 18F-FDG PET. Qualitatively, bone marrow activity is remarkably greater than mean liver activity.

 

Figure 2
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  		FIGURE 2.  Kaplan–Meier survival curves of NSCLC patients with bone marrow hypermetabolism (BM SUV > 1.7) on 18F-FDG PET vs. patients with normal bone marrow metabolism. BM SUV is normalized for lean body mass (lbm). Median survival of patients with bone marrow hypermetabolism was significantly shorter than that of NSCLC patients with normal bone marrow metabolism (151 vs. 799 d; P = 0.00006, log-rank test). BM = bone marrow.

 

Figure 3
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  		FIGURE 3.  Kaplan–Meier survival curves of NSCLC patients with high tumor SUV (weight-corrected mean SUVT > 10) on 18F-FDG PET vs. patients with less active primary tumors. Median survival of patients with elevated SUVT was significantly shorter (227 vs. 874 d; P = 0.003, log-rank test). T = primary tumor.

 




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