Bone marrow FDG-PET/CT in Hodgkin lymphoma revisited: do imaging and pathology match?

Purpose 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. Materials and 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 (SUV max ) 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. SUV max 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). Conclusion 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.