title: Bone marrow FDG-PET/CT in Hodgkin lymphoma revisited: do imaging and pathology match?
abstract: OBJECTIVE
  To directly compare visual and quantitative (18)F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) to bone marrow biopsy (BMB) findings in the right posterior iliac crest in patients with newly diagnosed Hodgkin lymphoma.
  
  
  METHODS
  This retrospective study included 26 patients with newly diagnosed Hodgkin lymphoma in whom FDG-PET/CT was performed before BMB of the right posterior iliac crest. The right posterior iliac crest was assessed for bone marrow involvement, both visually and semi-quantitatively [using maximum standardized uptake value (SUVmax) measurements]. BMB of right the posterior iliac crest was used as reference standard.
  
  
  RESULTS
  BMB of the right posterior iliac crest was positive in 5 (19.2 %) of 26 patients. There was full agreement between visual FDG-PET/CT and BMB findings in the right posterior iliac crest (i.e. no false-positive or false-negative FDG-PET/CT findings). Accordingly, sensitivity, specificity, positive predictive value, and negative predictive value of visual FDG-PET/CT assessment for the detection of bone marrow involvement in the right posterior iliac crest were 100 % (5/5) (95 % CI 51.1-100 %), 100 % (21/21) (95 % CI 81.8-100 %), 100 % (5/5) (95 % CI 51.1-100 %), and 100 % (21/21) (95 % CI 81.8-100 %), respectively. SUVmax of BMB-positive cases (mean ± SD: 3.4 ± 0.85) was nearly significantly higher (P = 0.052) than that of BMB-negative cases (mean ± SD 2.7 ± 0.63).
  
  
  CONCLUSIONS
  This histopathological correlation study confirms the very high diagnostic value of FDG-PET/CT in the detection of bone marrow involvement in newly diagnosed Hodgkin lymphoma, and supports the substitution of BMB with FDG-PET/CT in this setting.
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands, h.j.a.adams@gmail.com.
authors.forename: Hugo J A
authors.initials: HJ
authors.lastname: Adams
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Kwee
authors.forename: Rob
authors.initials: R
authors.lastname: Fijnheer
authors.forename: Steven V
authors.initials: SV
authors.lastname: Dubois
authors.forename: Rutger A J
authors.initials: RA
authors.lastname: Nievelstein
authors.forename: John M H
authors.initials: JM
authors.lastname: de Klerk
mesh_terms: D000328:Adult; D001853:Bone Marrow / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18