Fluorine-18 Fluorodeoxyglucose Splenic Uptake From Extramedullary Hematopoiesis After Granulocyte Colony-stimulating Factor Stimulation

Abstract

Two patients with sarcoma, one with recurrent osteosarcoma of the spine and the other with metastatic synovial cell sarcoma, were treated with high-dose chemotherapy that produced severe leukopenia. The patients received granulocyte colony-stimulating factor (G-CSF) to stimulate the bone marrow (480 mg given subcutaneously twice daily for 5 to 7 days); their responses were seen as a marked increase in peripheral leukocyte count with no change in the erythrocyte or platelet counts. The patients had fluorine-18 fluorodeoxyglucose (F-18 FDG) imaging 24 hours after the end of G-CSF treatment. Diffusely increased uptake of F-18 FDG was seen in the bone marrow in both patients. In addition, markedly increased uptake in the spleen was noted in both, indicating that the spleen was the site of extramedullary hematopoiesis. The patients had no evidence of splenic metastases. The first patient had a history of irradiation to the dorsal spine, which was less responsive to G-CSF administration than was the nonirradiated lumbar spine.

Assessment of bone marrow inflammation in patients with myelofibrosis: an 18F-fluorodeoxyglucose PET/CT study

“…However, myelopoiesis also contributes to the observed bone marrow signal [30], and the exact contribution of each process cannot be estimated from the results of this study. Nevertheless, the observed results indicate that 18 F-FDG PET/CT may become a promising technique for the quantitation of bone marrow involvement…”

“…Furthermore, 18 F-FDG PET/CT is widely used for evaluation of inflammatory diseases based on increased glucose metabolism in inflammatory processes [27,29]. EMH may exhibit increased 18 F-FDG uptake [30]. Early and robust inflammation is a hallmark of myelofibrosis pathophysiology, and may be a target for PET imaging.…”

Diffuse Bone Marrow Involvement of Hodgkin Lymphoma Mimics Hematopoietic Cytokine-Mediated FDG uptake on FDG PET Imaging

“…[1][2][3] Hematopoietic cytokines, such as granulocyte colony-stimulating factor (G-CSF) and granulocytemacrophage colony-stimulating factor cause increased FDG uptake in the bone marrow 4 and in the spleen. 5,6 In animal experiments, it has been shown that FDG activity in bone marrow continues to be elevated as long as 4 weeks after completion of G-CSF, and the elevated marrow FDG uptake was sustained longer than the period of blood neutrophil count elevation. 7 Hematopoietic cytokine-induced bone marrow FDG uptake is often diffuse.…”

18F-fluorideoxyglucose positron emission tomography/computed tomography imaging: Artifacts and pitfalls

“…Since the spleen is an active site for the extramedullary hematopoesis, a diffuse spleen enhancement of 18 F-FDG uptake represents in patients receiving hematopoietic growth factor (HGF), such as granulocyte colony stimulating factor (G-CSF) and erythropoietin [20,21].…”

“…An increased diffuse 18 F-FDG activity in the bone marrow may be seen also in the patients receiving HGF such as erythropoietin, G-CSF, and granulocyte macrophage colony-stimulating factor (GM-CSF) [20,21,25].…”