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Utility of quantitative FDG-PET/CT for the detection of bone marrow involvement in follicular lymphoma: a histopathological correlation study

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Abstract

Objective

To determine the value of visual and quantitative 18 F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) for the detection of bone marrow involvement in follicular lymphoma, using direct histopathological examination at the right posterior iliac crest as reference standard.

Materials and methods

This retrospective study included 22 patients with newly diagnosed follicular lymphoma who had undergone FDG-PET/CT before BMB of the right posterior iliac crest. FDG-PET/CT images were visually evaluated for bone marrow involvement in the right posterior iliac crest. Volumes of interest were placed in the right posterior iliac crest to calculate the 3D partial volume corrected mean standardized uptake value (cSUVmean), maximum standardized uptake value (SUVmax) and peak standardized uptake value (SUVpeak).

Results

Sensitivity and specificity of visual FDG-PET/CT analysis for the detection of bone marrow involvement in the right posterior iliac crest were 0.0 % (95 % confidence interval (CI): 0–32.4 %) and 100 % (95 % CI: 78.5–100 %), respectively. Areas under the receiver-operating characteristic curve of cSUVmean, SUVmax and SUVpeak for the detection of bone marrow involvement in the right posterior iliac crest were 0.85 (95 % CI: 0.63–0.96), 0.89 (95 % CI: 0.68–0.98) and 0.87 (95 % CI: 0.65–0.97), respectively. Optimal cutoff values for cSUVmean, SUVmax and SUVpeak were 1.3, 2.1 and 1.7, and yielded sensitivity and specificity combinations of 75.0 % and 85.7 %, 87.5 % and 85.7 % and 87.5 % and 85.7 %, respectively.

Conclusion

This histopathological correlation study shows that, unlike visual interpretation of FDG-PET/CT images, quantitative FDG-PET/CT analysis may be beneficial in diagnosing bone marrow involvement by follicular lymphoma.

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Abbreviations

cSUVmean :

3D partial volume corrected mean SUV

SUVmax :

maximum SUV

SUVpeak :

peak SUV

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Funding

This project was financially supported by an Alpe d’HuZes/Dutch Cancer Society Bas Mulder Award for T.C.K. (grant no. 5409) and by a ZonMW AGIKO stipend for T.C.K. (grant no. 92003497). Data collection, data analysis and interpretation of data, writing of the paper and the decision to submit were left to the authors’ discretion and were not influenced by Alpe d’HuZes/Dutch Cancer Society and ZonMW.

Potential conflicts of interest

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Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Hugo J. A. Adams, Thomas C. Kwee & Rutger A. J. Nievelstein

  2. Department of Hematology, Meander Medical Center, Amersfoort, The Netherlands

    Rob Fijnheer

  3. Department of Pathology, Meander Medical Center, Amersfoort, The Netherlands

    Stefan V. Dubois

  4. Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands

    Peter E. Blase & John M. H. de Klerk

Authors
  1. Hugo J. A. Adams
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  2. Thomas C. Kwee
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  3. Rob Fijnheer
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  4. Stefan V. Dubois
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  5. Peter E. Blase
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  6. Rutger A. J. Nievelstein
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  7. John M. H. de Klerk
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Corresponding author

Correspondence to Thomas C. Kwee.

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Adams, H.J.A., Kwee, T.C., Fijnheer, R. et al. Utility of quantitative FDG-PET/CT for the detection of bone marrow involvement in follicular lymphoma: a histopathological correlation study. Skeletal Radiol 43, 1231–1236 (2014). https://doi.org/10.1007/s00256-014-1919-1

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  • DOI: https://doi.org/10.1007/s00256-014-1919-1

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