Article Figures & Data
Figures
- FIGURE 1.
Diffuse bone marrow uptake pattern in 18F-FDG PET/CT. (A and B) Uptake lower than (A) or similar to (B) that in liver was considered negative for BMI. (C) Uptake higher than that in liver was always linked to anemia or inflammatory processes and also considered negative for BMI.
- FIGURE 2.
Unifocal bone marrow uptake pattern in 18F-FDG PET/CT. Focal lesion on right pelvic bone (A) was shown to be located on right part of sacrum (B), with no underlying anomaly on CT (C). Usual BMB in left posterior iliac crest was negative. Targeted MR imaging confirmed BMI. According to our criteria, patient was considered to have BMI.
- FIGURE 3.
Patient with negative initial BMB of left posterior iliac crest. (A) Initial 18F-FDG PET/CT highlighted multifocal uptake in bone marrow. Guided biopsy of right iliac crest came back positive. (B) 18F-FDG PET/CT monitoring revealed excellent metabolic response. According to our criteria, this patient was considered to have BMI.
- FIGURE 4.
Diagnostic performance of BMB and 18F-FDG PET/CT regarding BMI (95% CIs).
- FIGURE 5.
PFS according to BMB (A) or 18F-FDG PET/CT status (B).
- FIGURE 6.
PFS of patients with negative BMB (A) or positive BMB (B) considering their 18F-FDG PET/CT status.
Tables
- TABLE 1
Baseline Clinical Characteristics According to Bone Marrow Status by BMB or 18F-FDG PET/CT
BMB 18F-FDG PET/CT Characteristic BMI+ (n = 8) BMI− (n = 125) P BMI+* (n = 32) BMI−† (n = 101) P Male sex 4 (50) 63 (50) 1 21 (66) 46 (46) 0.07 IPI > 2 5 (63) 48 (38) 0.5 17 (53) 36 (36) 0.1 Age (y) 59 ± 11 57 ± 15 0.6 59 ± 10 57 ± 16 0.3 Age ≥ 60 y 4 (50) 64 (51) 1 15 (47) 53 (52) 0.7 LDH+ 5 (63) 79 (63) 1 23 (72) 61 (60) 0.3 Stage III/IV 8 (100) 91 (73) 0.1 28 (88) 70 (70) 0.06 ECOG ≥ 2 2 (25) 21 (17) 0.6 7 (22) 16 (16) 0.4 Extranodal involvement > 1 5 (63) 23 (18) 0.01 11 (34) 17 (17) 0.05 BMB/BMI+ — — — 6 (19) 2 (2) 0.003 PET/BMI+ 6 (75) 26 (21) 0.003 — — — ↵* Presence of clear-cut 18F-FDG–avid bone marrow foci (unifocal of multifocal) consistent with BMI.
↵† Absence of clear-cut 18F-FDG–avid bone marrow foci (intense but homogeneous uptake is considered negative).
Qualitative data are expressed as numbers, followed by percentages in parentheses; continuous data are expressed as mean ± SD.
Univariate analysis Multivariate analysis Characteristic HR 95% CI P HR 95% CI P BMB/BMI+ 4.86 1.62–14.58 0.05 2.20 0.80–6.04 0.1 PET/BMI+ 2.89 1.20–6.98 0.02 2.48 1.15–5.33 0.02 IPI > 2 4.54 1.73–11.93 0.002 3.11 1.42–6.80 0.005 Age > 60 y 1.94 0.77–4.88 0.2 — — — Stage III or IV 2.38 0.69–8.13 0.2 — — — ECOG ≥ 2 5.85 2.39–14.39 <0.001 — — — LDH+ 3.65 1.07–12.48 0.04 — — — Extranodal site > 1 2.96 1.21–7.26 0.02 — — — Univariate analysis Multivariate analysis Characteristic HR 95% CI P HR 95% CI P BMB/BMI+ 4.10 1.36–12.36 0.01 2.67 0.87–8.21 0.09 PET/BMI+ 2.81 1.16–6.78 0.02 2.17 0.88–5.33 0.09 IPI > 2 4.59 1.75–12.03 0.002 4.15 1.57–10.95 0.004 Age > 60 y 2.08 0.83–5.29 0.1 — — — Stage III or IV 2.53 0.74–8.69 0.1 — — — ECOG ≥ 2 6.80 2.72–17.12 <0.001 — — — LDH+ 3.52 1.03–12.03 0.04 — — — Extranodal site > 1 2.88 1.17–7.06 0.02 — — — - TABLE 4
Correlation Between 18F-FDG PET/CT and BMB Results and Final Bone Marrow Status in Our Study
18F-FDG PET/CT BMB Final status BMI+ BMI− BMI+ BMI− BMI+ 31 2 8 25 BMI− 1 99 0 100 n = 133.
- TABLE 5
Correlation Between 18F-FDG PET/CT and BMB Results and Final Bone Marrow Status in 3 Studies
18F-FDG PET/CT BMB Study n Final status BMI+ BMI− BMI+ BMI− Mittal et al. (23) 60 BMI+ 25 0 19 6 BMI− 2 33 0 35 Muslimani et al. (16) 57 BMI+ 20 3 — — BMI− 2 32 — — Pelosi et al. (15) 120 BMI+ 21 4 10 15 BMI− 0 95 0 95 Overall 237 and 180 BMI+ 66 7 29 21 BMI− 4 160 0 130
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