Nuclear medicine

The researches find that the 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) is use for staging classical Hodgkin lymphoma ; therefore (cHL) with high sensitivity for skeletal involvement. However; it is unclear whether a single bone lesion carries the same adverse prognosis as multifocal lesions and if this is affect by type of chemotherapy ABVD (adriamycin, bleomycin, vincristine; dacarbazine) versus BEACOPP (bleomycin; etoposide; adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone).

Type of chemotherapy

They review the clinico-pathological and outcome data from 209 patients with newly diagnose cHL staged by FDG-PET/CT. Patterns of skeletal/bone marrow uptake (BMU) are divide into ‘low’ and ‘high’ diffuse BMU (i.e. without focal lesions); and unifocal or multifocal lesions. Additional separate survival analysis was perform; taking type of chemotherapy into account. Forty patients (192%) had skeletal lesions (20 unifocal, 20 multifocal).

The 3-year progression-free-survival (PFS) was 80% for patients with ‘low BMU’, 87% for ‘high BMU’, 69% for ‘unifocal’ and 51% for ‘multifocal’ lesions; median follow-up was 38 months. The presence of bone lesions, both uni- and multifocal, is associate with significantly inferior PFS (log rank P = 00001), independent of chemotherapy type.

The clinico-pathological

Thus, increased diffuse BMU should not be consider as a risk factor in cHL, whereas unifocal or multifocal bone lesions should be regard as important predictors of adverse outcome, irrespective of the chemotherapy regimen used.PET/CT acquisition. Staging FDG PET/CT scans are carry out in accordance with local protocols and manufacturer guidelines.

After unenhance CT scans for attenuation correction and anatomic co-registration, FDG PET imaging is perform, follow by a contrast-enhance CT if not already perform prior to the staging PET. Both PET and CT images are store locally. Image reports from the time of the original scans are not use for the study analysis. Image analysis.

CT scans for attenuation

FDG PET/CT scans were retrieved from local databases at Aarhus and Uppsala University Hospitals and reviewed de novo by two experienced nuclear medicine physicians using a Hermes workstation in Aarhus and a GE workstation in Uppsala.
Images were reviewed specifically for bone marrow involvement, taking note of focal and intense FDG uptake in the
skeleton, irrespective of the presence or absence of osteolytic or non-osteolytic lesions.

Criteria for FDG uptake in bone marrow to be classified as due to HL were: (i) FDG uptake above liver, (ii) no anatomical changes to suggest alternative ‘benign’ bone pathology, and (iii) to have resolved in parallel with nodal disease during treatment. Bone lesions were categorized as multifocal if more than one lesion was present.