Measuring the "Unmeasurable" Assessment of Bone Marrow Response to Therapy Using FDG-PET in Patients with Lymphoma

Behnaz Goudarzi, Heather A. Jacene, Richard L. Wahl

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Rationale and Objectives: To determine if anatomically " nonmeasurable" disease in bone marrow (BM) is assessable for response to therapy by [18F]-2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT). Materials and Methods: FDG PET/CT images of 27 patients with lymphoma, FDG-avid bone marrow (BM) lesions, and ≥1 FDG-avid, tumor-involved lymph node (LN) at baseline were retrospectively reviewed. FDG uptake in target LNs and BM foci was determined pre- and posttherapy using the standardized uptake value corrected for lean body mass (SULmean). Size of the same target LNs was measured pre- and posttherapy on CT. Percentage decreases of LN size and LN and BM SUL were calculated. Response was classified according to revised International Workshop Criteria (IWC) with and without modification for metabolic evaluation of BM and correlated to overall survival. Statistical analyses were performed using paired t-tests, Pearson correlation coefficients, and z-tests. Results: LN size, LN SULmean, and BM SULmean were significantly higher pre- versus posttherapy (2337 mm2 ± 1810 vs. 309 mm2 ± 323; 6.94 ± 4.96 vs 1.02 ± 1.00; and 6.81 ± 4.58 to 1.84 ± 1.58, all P < 001, respectively). After therapy, significant correlation was found between percentage declines of LN size and SULmean of LNs (r = 0.84, P < 001) or BM (r = 0.56, P = .002) and SULmean of LN and BM (r = 0.76, P < 001). Including a metabolic assessment of BM correctly altered overall response assessment in 5/27 (19%) patients and better predicted overall survival than revised IWC. Conclusion: Anatomically " unmeasurable" BM infiltration with lymphoma behaves similarly to LN disease after therapy and is " measurable" by FDG PET/CT. FDG PET/CT is valuable for monitoring tumor response in " measurable" disease and BM, which was previously considered " unmeasurable" by anatomical imaging.

Original languageEnglish (US)
Pages (from-to)1175-1185
Number of pages11
JournalAcademic radiology
Issue number9
StatePublished - Sep 2010
Externally publishedYes


  • Bone marrow
  • FDG
  • Lymphoma
  • PET/CT
  • Response assessment

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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