Usefulness and pitfalls of F-18-FDG PET/CT for diagnosing extramedullary acute leukemia

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• 作者：Wen-lan Zhou¹ ; ^{wenlanzhou@163.com" class="auth_mail" title="E-mail the corresponding author} ; Hu-bing Wu ; ^{wuhbym@163.com" class="auth_mail" title="E-mail the corresponding author} ; Li-juan Wang¹ ; Ying Tian¹ ; Ye Dong¹ ; Quan-shi Wang ; ^{wqslph@163.net" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Acute leukemia ; Extramedullary ; Diagnosis ; PET/CT ; 18F-FDG
• 刊名：European Journal of Radiology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：85
• 期：1
• 页码：205-210
• 全文大小：1120 K

文摘

It is very important to identify whether there is extramedullary involvement in acute leukemia (AL), especially in those with recurrent disease. This retrospective study aimed to assess the role of ¹⁸F-FDG PET/CT for diagnosing extramedullary AL.

Materials and methods

PET/CT examinations were performed in 9 patients with newly diagnosed AL, and 70 patients suspected to have recurrent AL. All the patients were diagnosed with AL by bone marrow biopsy. The diagnosis of extramedullary lesions was established according to the combination of pathology, physical examination, and imaging techniques including magnetic resonance imaging (MRI) and PET/CT, and/or cerebrospinal fluid (CSF) cytologic testing, and clinical follow-up.

Results

Of the 79 patients, including 34 acute lymphocytic leukemia (ALL) and 45 acute myeloid leukemia (AML) cases, 30 patients were diagnosed with extramedullary AL. ¹⁸F-FDG PET/CT demonstrated ¹⁸F-FDG positive lesions in the extramedullary regions in 42 patients. Among them, 28 patients were diagnosed to have extramedullary AL and the other 14 were diagnosed with non-hematological malignancies (false positive disease). The sensitivity, specificity, and accuracy of ¹⁸F-FDG PET/CT in diagnosing extramedullary involvement of AL were 93.3% (28/30), 71.4% (35/49), and 79.7%, respectively. The ¹⁸F-FDG uptake of lesions was not significantly different between extramedullary AL and false positive cases (SUVmax: 6.66 ± 2.65 vs. 5.85 ± 1.88, t = 1.275, P = 0.206). The FDG uptake of extramedullary AL between ALL and AML were also not significantly different (SUVmax: 7.01 ± 2.82 vs. 6.10 ± 2.29, t = 1.332, P = 0.188). The predominant locations of extramedullary AL were the spleen, soft tissue, lymph nodes, central nerve system, liver, testis, and kidney. A total of 48.2% (27/56) of extramedullary AL lesions presented as diffuse FDG uptake compared with 6.25% (1/16) in the false positive lesions (χ² = 9.221, P = 0.002).

Conclusion

¹⁸F-FDG PET/CT is a sensitive, but not specific imaging modality for diagnosing extramedullary AL. Diffuse ¹⁸F-FDG uptake in extramedullary lesions may indicate leukemia involvement.