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A bone marrow F-18 FDG uptake exceeding the liver uptake may indicate bone marrow hyperactivity

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Abstract

Objective

In clinical positron emission tomography (PET) studies for oncology, it is occasionally required to differentiate a diffuse increase in bone marrow (BM) F-18 fluoro-2-deoxyglucose (FDG) uptake due to the involvement of malignancy or hematopoietic disease and that due to the administration of hematopoietic cytokines, an inflammation reaction, or stimulation by some types of malignancy. The objectives of this study were to clarify the relationships between BM F-18 FDG uptake and blood parameters as well as age, and also to determine the degree of F-18 FDG accumulation that constitutes an abnormal level referring to blood parameters.

Methods

Records of 65 patients, 32 with benign diseases and 33 with malignancies without metastasis in bone and liver until a half year after the PET examination, were analyzed retrospectively. Regions of interest were placed on the liver and the lower thoracic and lumbar vertebrae to measure the standardized uptake value (SUV), and vertebral SUVs were averaged as the BM SUVmean. The BM SUVmean was divided by the liver SUV to calculate the BM/liver ratio. The relationships among the BM SUVmean, or BM/liver ratio, and blood parameters and age were tested using multiple regression analysis.

Results

In both patients with and without malignancy, a multiple regression model using the BM/liver ratio showed a higher coefficient of determination value than that using the BM SUVmean, indicating that the correction by the liver SUV reduced the interindividual variation in the BM SUVmean. The BM/liver ratio was negatively correlated with age (β = −0.41 and −0.43, respectively) and positively correlated with serum C-reactive protein (CRP) level (β = 0.39 and 0.46, respectively) in both groups of patients. Every patient with benign disease who had a ratio greater than or equal to 1 had an increased CRP level.

Conclusions

The BM F-18 FDG uptake depends on the patient’s age and serum CRP level, both with and without malignancy. A BM F-18 FDG uptake greater than or equal to that of the liver may indicate BM activation.

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Acknowledgments

The authors thank the technical staff of Tohoku University Hospital for PET data acquisition. This study was supported by the Ministry of Education, Culture, Sports, Science and Technology, a Grant-in-Aid for Young Scientists (B), 19790852 and a Grant-in-Aid for Cancer Research (17-12) from the Ministry of Health, Labour and Welfare, Japan.

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Authors and Affiliations

  1. Department of Nuclear Medicine and Radiology, Institute of Development, Aging, and Cancer, Tohoku University, 4-1 Seiryomachi, Aoba-ku, Sendai, 980-8575, Japan

    Kentaro Inoue, Ryoi Goto, Ken Okada, Shigeo Kinomura & Hiroshi Fukuda

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  1. Kentaro Inoue
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  2. Ryoi Goto
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  3. Ken Okada
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Correspondence to Kentaro Inoue.

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Inoue, K., Goto, R., Okada, K. et al. A bone marrow F-18 FDG uptake exceeding the liver uptake may indicate bone marrow hyperactivity. Ann Nucl Med 23, 643–649 (2009). https://doi.org/10.1007/s12149-009-0286-9

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  • DOI: https://doi.org/10.1007/s12149-009-0286-9

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