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Chaouki A, Roelants V, Gheysens O, Bailly S, Krug B. Extramedullary Hematopoiesis in Treated Diffuse Large B-Cell Lymphoma of Bone. Clin Nucl Med 2023; 48:1066-1067. [PMID: 37882755 DOI: 10.1097/rlu.0000000000004885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
ABSTRACT A 65-year-old man with a history of diffuse large B-cell bone lymphoma of the right radius underwent an interim FDG PET/CT after 2 cycles of chemotherapy. Besides a complete metabolic response on the primary site, images revealed a hypermetabolic nodule in the posterior mediastinum, not present on the initial images. The metabolic activity of the nodule was similar to that of the reactive bone marrow and disappeared, concomitantly to the normalization of the medullar signal on the posttreatment images. The similarity and synchronous metabolic activity evolution in the nodule and bone marrow indicate extramedullary hematopoiesis.
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Affiliation(s)
- Amine Chaouki
- From the Department of Nuclear Medicine, CHU UCL Namur, Godinne Site, Université Catholique de Louvain
| | | | | | - Sarah Bailly
- Adult Hematology, Cliniques Universitaires Saint-Luc, Brussels, Université Catholique de Louvain, Leuven, Belgium
| | - Bruno Krug
- From the Department of Nuclear Medicine, CHU UCL Namur, Godinne Site, Université Catholique de Louvain
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2
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Campbell BA, Callahan J, Cole-Sinclair M, MacManus M, Hofman MS. 18F-Fluorothymidine PET for Functional Response Assessment Following Radiation Therapy for Extramedullary Hematopoiesis. Clin Nucl Med 2021; 46:e454-e457. [PMID: 33661206 DOI: 10.1097/rlu.0000000000003566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT As a marker of cellular proliferation, 18F-fluorothymidine (FLT) PET can detect the distribution of proliferating hematopoiesis and has an emerging role in the investigation of hematopoietic disorders. These images demonstrate the novel utility of 18F-FLT PET for imaging sites of extramedullary hematopoiesis (EMH) in a patient with Chuvash-type polycythemia and suggest a role for 18F-FLT PET in response assessment following radiotherapy. Further, the discordant response observed in the irradiated marrow and sites of EMH is a unique discovery, possibly suggesting the influence of the microenvironment favoring more rapid recovery of proliferative function within EMH sites.
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Affiliation(s)
| | | | - Merrole Cole-Sinclair
- Department of Haematology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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Anemia and PET imaging. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00442-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lenograstim-Induced Nodal Extramedullary Hematopoiesis: A Challenging Diagnosis in Lymphoma Evaluation With 18F-FDG PET/CT. Clin Nucl Med 2020; 45:e373-e375. [PMID: 32558708 DOI: 10.1097/rlu.0000000000003111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the case of a 23-year-old man with nodal EMH (extramedullary hematopoiesis) occurring during treatment for a stage IIA "gray-zone" lymphoma. Although it is often related to myeloproliferative bone marrow disease, benign etiologies such as lenograstim treatment after chemotherapy can also induce EMH and be responsible for false-positive F-FDG PET/CT examinations. In this respect, GLUT overexpression in hematopoietic lineages and macrophages of the inflammatory environment are responsible for increased F-FDG uptake. Histopathologic confirmation of new hypermetabolic lesions on follow-up PET/CT may be required when the new lesions do not conform with the treatment responses in the preexisting lesions.
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Développement d'un sarcome sur foyer ectopique hématopoïétique secondaire à une sphérocytose héréditaire : à propos d'un cas et revue de la littérature. Rev Med Interne 2020; 41:559-561. [DOI: 10.1016/j.revmed.2020.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 04/26/2020] [Accepted: 05/13/2020] [Indexed: 11/17/2022]
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Marrow outside marrow: imaging of extramedullary haematopoiesis. Clin Radiol 2020; 75:565-578. [PMID: 31973940 DOI: 10.1016/j.crad.2019.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 12/13/2019] [Indexed: 01/18/2023]
Abstract
Extramedullary haematopoiesis (EMH) refers to the formation of non-neoplastic blood cell lines outside the bone marrow and is a common incidental finding when patients with haematological disorders are imaged. EMH presenting as mass (tumefactive EMH) has long been a radiological conundrum as it resembles neoplasms. Several imaging findings have been described in EMH, and these vary depending on the activity of the underlying haematopoiesis. The older lesions are easier to diagnose as they often demonstrate characteristic findings such as haemosiderin and fat deposition. In comparison, the newer, actively haematopoietic lesions often mimic neoplasms. Molecular imaging, particularly 99mTc labelled sulphur colloid scintigraphy, may be helpful in such cases. Although imaging is extremely useful in detecting and characterising EMH, imaging alone is often non-diagnostic as no single mass shows all the typical findings. Hence, a judgement based on the clinical background, combination of imaging findings, and slow interval growth may be more appropriate and practical in making the correct diagnosis. In every case, an effort has to be made in providing an imaging-based diagnosis as it may prevent a potentially risky biopsy. When confident differentiation is not possible, biopsy has to be resorted to. This article describes the causes, pathophysiology, and theories underlying the genesis of EMH, followed by the general and location-specific imaging findings. The purpose is to provide a thorough understanding of the condition as well as enable the clinical radiologist in making an imaging-based diagnosis whenever possible and identify the situations where biopsy has to be performed.
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Hereditary Spherocytosis Presenting as Diffuse Bone Marrow Activation and Splenomegaly on PSMA-Targeted 18F-DCFPyL PET/CT. Clin Nucl Med 2019; 44:e313-e314. [PMID: 30789396 DOI: 10.1097/rlu.0000000000002489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We present the case of a 71-year-old man with Gleason 3 + 3 = 6 pT2N0MxR0 adenocarcinoma of the prostate who presented with rising PSA level 16 years after radical prostatectomy. PSMA-targeted F-DCFPyL PET/CT was performed, which demonstrated recurrent disease in the prostatectomy bed as well as splenomegaly and mild-diffuse bone marrow activation, consistent with the patient's history of hereditary spherocytosis. We briefly review the clinical characteristics of hereditary spherocytosis, its appearance on molecular imaging studies, the normal biodistribution of F-DCFPyL, and the PSMA-RADS scoring system for characterizing findings on PSMA-targeted PET imaging.
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Kumar G, Khadwal A, Sood A, Singh H, Dasagrandhi V, Kashyap S, Mittal BR. What is this image? 2018: Image 3 result : Extramedullary hematopoiesis at unusual site detected with 99mTc-labeled RBC imaging and 18F-FLT PET/CT. J Nucl Cardiol 2018; 25:1903-1905. [PMID: 30382504 DOI: 10.1007/s12350-018-01462-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Ganesh Kumar
- Department of Nuclear Medicine, PGIMER, Chandigarh, 160012, India
| | - Alka Khadwal
- Department of Internal Medicine, PGIMER, Chandigarh, 160012, India
| | - Ashwani Sood
- Department of Nuclear Medicine, PGIMER, Chandigarh, 160012, India.
| | - Harmandeep Singh
- Department of Nuclear Medicine, PGIMER, Chandigarh, 160012, India
| | | | - Sonia Kashyap
- Department of Internal Medicine, PGIMER, Chandigarh, 160012, India
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van der Bruggen W, Hirschmann MT, Strobel K, Kampen WU, Kuwert T, Gnanasegaran G, Van den Wyngaert T, Paycha F. SPECT/CT in the Postoperative Painful Knee. Semin Nucl Med 2018; 48:439-453. [PMID: 30193650 DOI: 10.1053/j.semnuclmed.2018.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This review summarizes the role of SPECT/CT in patients with a painful postoperative knee and describes typical diagnostic criteria in these patients. Pain after knee surgery is common and is influenced by the underlying pathology, the type of surgery, and the patient. Knee joint-preserving surgery includes osteotomy, ligament reconstruction, meniscus surgery, and cartilage repair procedures, often used in combination. Knee arthroplasty procedures consist of unicondylar, patellofemoral, and primary or revision total knee prosthesis. In patients with pain after knee joint-preserving surgery, MRI remains the reference standard. After ligament reconstruction, CT can evaluate postoperative tunnel positioning, and bone SPECT/CT can contribute by assessing overloading or biodegradation problems. After meniscal or cartilage surgery, SPECT/CT can be particularly helpful to identify compartment overloading or nonhealing chondral or osteochondral lesions as cause of pain. SPECT/CT arthrography can assess cartilage damage at an early stage due to altered biomechanical forces. After corrective osteotomy of the knee, SPECT/CT can reveal complications such as overloading, nonunion, or patellofemoral problems. After arthroplasty, conventional radiographs lack both sensitivity to detect aseptic loosening and specificity in differentiating aseptic from infectious loosening. Secondly, hardware-induced artifacts still hamper CT and MRI, despite improving and increasingly available metal artifact reduction techniques. Bone scintigraphy is a proven useful adjunct to conventional radiography and MRI to reveal the pain generator and is less hampered by artifacts from metallic implants compared with CT and MRI. Nevertheless, the optimal imaging strategy in evaluating complications after knee arthroplasty is still a matter of debate. Although the evidence of the use of BS SPECT/CT is still limited, it is growing steadily. In particular, recent data on specific uptake patterns in tibial and femoral zones after total knee arthroplasty and the impact of integrating biomechanics into the assessment of SPECT/CT appear promising, but more research is needed.
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Affiliation(s)
- Wouter van der Bruggen
- Department of Radiology and Nuclear Medicine, Slingeland Hospital, Doetinchem, The Netherlands..
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland
| | - Klaus Strobel
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Torsten Kuwert
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Gopinath Gnanasegaran
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Frédéric Paycha
- Department of Nuclear Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
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Adams HJA, Kwee TC. Guest Editorial on PET of Benign Musculoskeletal Conditions. Semin Nucl Med 2017; 47:320-321. [PMID: 28583273 DOI: 10.1053/j.semnuclmed.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, Deventer Ziekenhuis, Deventer, The Netherlands.
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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