A comparative analysis of 18F-FDG PET/CT and MRI in bone marrow necrosis
Objective To explore the fluoro-18-deoxyglucose(18F-FDG)positron emission tomography/computed tomography(PET/CT)features of bone marrow necrosis and improve the understanding of the disease.Methods The PET/CT and clinical data of 9 patients with bone marrow necrosis diagnosed by magnetic resonance imaging(MRI)were retrospectively analyzed.Compared to MRI,the distribution of lesions was summarized.The 18F-FDG metabolic and CT features of the selected largest lesion were analyzed.Results There were 6 males and 3 females with a median age of 28.0 years.All patients were diagnosed with lymphoma.MRI scans of the hip,spine and knee were performed in 6,2,and 1 case respectively.The iliac lesions in 6 cases showed internal high signal intensity on T1-weighted images(T1WI),low signal intensity on T2-fat suppressed images(T2FSI),and peripheral linear hypointensity on T1WI.The iliac lesions in 5 cases demonstrated internal decreased 18F-FDG metabolism,peripheral linear increased 18F-FDG uptake and density on PET/CT.The iliac lesion in one case did not show abnormal 18F-FDG metabolism and density on PET/CT,the lesion was narrow and long on MRI.The vertebral lesions in two cases showed isointensity to hypointensity on T1WI and hyperintensity on T2FSI.On PET/CT,one vertebral lesion was isometabolic with slightly higher density,the other vertebral lesion showed reduced 18F-FDG metabolism with normal density.One femoral lesion showed high signal intensity on T1WI and low signal intensity on T2FSI,with increased 18F-FDG metabolism and density on PET/CT.PET/CT revealed more lesions beyond the scan range of MRI in 8 cases.In 8 cases,abnormal signs were demonstrated on much earlier PET/CT scans performed at a median time about 13.5(8.25,32.75)months before the MRI scan,but no one complained of any related discomfort at that time.The iliac lesions in 5 cases had decreased 18F-FDG uptake,of which 3 lesions showed peripheral linear high-density,and 2 lesions showed no abnormal density.The iliac lesion in one case did not show abnormal 18F-FDG metabolism and density.One vertebral lesion showed reduced metabolism and isodensity.In the case with knee MRI,the earlier PET/CT showed multiple linear increased 18F-FDG uptake in the bilateral femoral heads and the humerus heads,without abnormal density.During follow up PET/CT scans,the femoral head lesions in 3 cases showed cortical fracture and collapse,the vertebral lesions 2 cases demonstrated multiple Schmorl's nodules or compression fracture.Conclusion Decreased 18F-FDG uptake,with probably subsequent peripheral linear increased metabolism and density,is a common PET/CT feature of bone marrow necrosis.PET/CT is helpful to detect bone marrow necrosis and find multiple skeletal lesions.
bone marrow necrosisosteonecrosis18F-fluorodeoxyglucosepositron emission tomography/computed tomography
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