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  Indian J Med Microbiol
 

Figure 5: Maximum intensity projection (MIP) image (a) of a patient with Hodgkin's lymphoma (HL) shows homogenously diffuse fluoro-deoxy-glucose (FDG) uptake in the marrow of the entire skeleton. This image represents the patterns of bone marrow F-18 FDG uptake and their relevance in predicting bone marrow involvement (BMI). Diffuse FDG uptake in a patient with HL occurs due to cytokine induced reactive bone marrow uptake and does not usually reflect BMI;[7] accordingly bilateral iliac crest biopsies were negative in this patient. On the contrary focal and heterogeneously diffuse F-18 FDG uptake in marrow is highly predictive of BMI.[8] MIP image of a patient with diffuse large B cell lymphoma (DLBCL) (b) shows heterogenous F-18 FDG uptake in the entire marrow and also increased F-18 FDG uptake in right iliac crest, (d) the iliac crest biopsy was positive for BMI in this patient. MIP image (c) of another patient with DLBCL shows focal FDG uptake in left iliac bone. However iliac crest biopsy was negative for BMI as FDG uptake (e) was a bit distant from usual iliac crest biopsy site and was not sampled. However, the same focal FDG uptake (f) resolved after four cycles of chemotherapy confirming BMI. A positron emission tomography (PET) directed biopsy at the time of staging would have probably revealed BMI in this case. On the contrary FDG PET/CT has low sensitivity in detecting BMI in patients with low grade lymphoma as illustrated in these images (g and h). MIP image (g) and sagittal section images (h) of patient with small lymphocytic lymphoma does not show any significant FDG uptake in entire skeleton. However iliac crest biopsy revealed BMI in this patient

Figure 5: Maximum intensity projection (MIP) image (a) of a patient with Hodgkin's lymphoma (HL) shows homogenously diffuse fluoro-deoxy-glucose (FDG) uptake in the marrow of the entire skeleton. This image represents the patterns of bone marrow F-18 FDG uptake and their relevance in predicting bone marrow involvement (BMI). Diffuse FDG uptake in a patient with HL occurs due to cytokine induced reactive bone marrow uptake and does not usually reflect BMI;<sup>[7]</sup> accordingly bilateral iliac crest biopsies were negative in this patient. On the contrary focal and heterogeneously diffuse F-18 FDG uptake in marrow is highly predictive of BMI.<sup>[8]</sup> MIP image of a patient with diffuse large B cell lymphoma (DLBCL) (b) shows heterogenous F-18 FDG uptake in the entire marrow and also increased F-18 FDG uptake in right iliac crest, (d) the iliac crest biopsy was positive for BMI in this patient. MIP image (c) of another patient with DLBCL shows focal FDG uptake in left iliac bone. However iliac crest biopsy was negative for BMI as FDG uptake (e) was a bit distant from usual iliac crest biopsy site and was not sampled. However, the same focal FDG uptake (f) resolved after four cycles of chemotherapy confirming BMI. A positron emission tomography (PET) directed biopsy at the time of staging would have probably revealed BMI in this case. On the contrary FDG PET/CT has low sensitivity in detecting BMI in patients with low grade lymphoma as illustrated in these images (g and h). MIP image (g) and sagittal section images (h) of patient with small lymphocytic lymphoma does not show any significant FDG uptake in entire skeleton. However iliac crest biopsy revealed BMI in this patient