title: Variety in bone marrow 18F-FDG uptake in Hodgkin lymphoma patients without lymphomatous bone marrow involvement: does it have an explanation?
abstract: OBJECTIVE
  To directly correlate fluorine-18 fluoro-2-deoxy-D-glucose (F-FDG) uptake of the iliac crest, as determined with PET, with both spatially matched histological bone marrow parameters and laboratory markers in Hodgkin lymphoma patients without lymphomatous bone marrow involvement at bone marrow biopsy.
  
  
  METHODS
  This retrospective study included 21 patients with newly diagnosed Hodgkin lymphoma who underwent F-FDG-PET and who had a lymphoma-negative bone marrow biopsy of the right posterior iliac crest. F-FDG-PET maximum standardized uptake value (SUVmax) was measured in the right posterior iliac crest and correlated to histological bone marrow parameters (cellularity, myeloid/erythroid ratio, degree of fibrosis, and reactive T- and B-lymphocytes) and laboratory markers (hemoglobin, C-reactive protein lactate dehydrogenase, and leukocyte and thrombocyte counts) using Pearson's correlation coefficient (R) for Gaussian data or Kendall's tau (τ) for non-Gaussian data.
  
  
  RESULTS
  There was a significant moderate correlation between F-FDG-PET SUVmax and cellularity of the iliac crest (R=0.519, P=0.016). Furthermore, there was a significant strong inverse correlation between F-FDG-PET SUVmax of the iliac crest and hemoglobin level (R=-0.661, P=0.001) and there was a significant moderate correlation between F-FDG-PET SUVmax of the iliac crest and C-reactive protein level (τ=0.441, P=0.007). All other correlations, including F-FDG-PET SUVmax of the right iliac crest versus reactive T- and B-lymphocytes in the bone marrow, were not significant.
  
  
  CONCLUSIONS
  The observations suggest increased bone marrow F-FDG uptake to be caused by red marrow hyperplasia because of anemia in Hodgkin lymphoma. Increased bone marrow F-FDG uptake is unlikely to be caused by inflammatory bone marrow changes.
authors.affiliation: aDepartment of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht Departments of bNuclear Medicine cHematology dRadiology ePathology, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Hugo J A
authors.initials: HJ
authors.lastname: Adams
authors.forename: John M H
authors.initials: JM
authors.lastname: de Klerk
authors.forename: Rob
authors.initials: R
authors.lastname: Fijnheer
authors.forename: Ben G F
authors.initials: BG
authors.lastname: Heggelman
authors.forename: Stefan V
authors.initials: SV
authors.lastname: Dubois
authors.forename: Rutger A J
authors.initials: RA
authors.lastname: Nievelstein
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Kwee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001692:Biological Transport; D014408:Biomarkers, Tumor / Q000378:metabolism; D001853:Bone Marrow / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism*; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D019788:Fluorodeoxyglucose F18