title: [18F]Fluorodeoxyglucose positron emission tomography for detection of bone marrow involvement in children and adolescents with Hodgkin's lymphoma.
abstract: OBJECTIVE
  Currently, a routine bone marrow biopsy (BMB) is performed to detect bone marrow (BM) involvement in pediatric Hodgkin's lymphoma (HL) stage greater than IIA. [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) is increasingly used for the initial staging of HL. The value of using FDG-PET to detect BM involvement has not been sufficiently defined. We compared the results of BMBs and FDG-PET for the diagnosis of BM involvement in a large pediatric group with HL.
  
  
  METHODS
  The initial staging of 175 pediatric patients with newly diagnosed classical HL stage greater than IIA was determined by using BMB, FDG-PET, chest computed tomography (CT), and magnetic resonance imaging (MRI) or CT of the neck, abdomen, and pelvis. Staging images were prospectively evaluated by a central review board. Skeletal regions that were suggestive of BM involvement by either method were re-evaluated by using different imaging modalities. In suspicious cases, bone scintigraphy was performed. If follow-up FDG-PET scans were available, the remission of skeletal lesions during treatment was evaluated.
  
  
  RESULTS
  BMB results were positive in seven of 175 patients and were identified by FDG-PET. FDG-PET scans showed BM involvement in 45 patients. In addition, the lesions of 32 of these 45 patients had a typical multifocal pattern. In 38 of 39 follow-up positron emission tomography scans, most of the skeletal lesions disappeared after chemotherapy. There was no patient with skeletal findings suggestive of BM involvement by MRI or CT with a negative FDG-PET.
  
  
  CONCLUSIONS
  FDG-PET is a sensitive and specific method for the detection of BM involvement in pediatric HL. The sensitivity of a BMB appears compromised by the focal pattern of BM involvement. Thus, FDG-PET may safely be substituted for a BMB in routine staging procedures.
authors.affiliation: Department of Nuclear Medicine, University of Leipzig, Liebigstrasse 18, 04103 Leipzig, Germany. sandra.purz@medizin.uni-leipzig.de
authors.forename: Sandra
authors.initials: S
authors.lastname: Purz
authors.forename: Christine
authors.initials: C
authors.lastname: Mauz-Körholz
authors.forename: Dieter
authors.initials: D
authors.lastname: Körholz
authors.forename: Dirk
authors.initials: D
authors.lastname: Hasenclever
authors.forename: Antje
authors.initials: A
authors.lastname: Krausse
authors.forename: Ina
authors.initials: I
authors.lastname: Sorge
authors.forename: Kathrin
authors.initials: K
authors.lastname: Ruschke
authors.forename: Martina
authors.initials: M
authors.lastname: Stiefel
authors.forename: Holger
authors.initials: H
authors.lastname: Amthauer
authors.forename: Otmar
authors.initials: O
authors.lastname: Schober
authors.forename: W Tilman
authors.initials: WT
authors.lastname: Kranert
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Weber
authors.forename: Uwe
authors.initials: U
authors.lastname: Haberkorn
authors.forename: Patrick
authors.initials: P
authors.lastname: Hundsdörfer
authors.forename: Karoline
authors.initials: K
authors.lastname: Ehlert
authors.forename: Martina
authors.initials: M
authors.lastname: Becker
authors.forename: Jochen
authors.initials: J
authors.lastname: Rössler
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Kulozik
authors.forename: Osama
authors.initials: O
authors.lastname: Sabri
authors.forename: Regine
authors.initials: R
authors.lastname: Kluge
mesh_terms: D000293:Adolescent; D001706:Biopsy; D019046:Bone Marrow Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary*; D002648:Child; D005260:Female; D019788:Fluorodeoxyglucose F18; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18