BMC medical imaging · 2026
18F-FDG PET/CT in the evaluation of femoral head osteonecrosis in patients with lymphoma.
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Song Le, Li Hui, Zhu Anhui, Zhang Weifang
Аннотация
OBJECTIVE: To describe the imaging features of osteonecrosis of the femoral head (ONFH) on 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT and explore whether PET/CT can raise suspicion for ONFH in patients with lymphoma.
METHODS: A retrospective analysis was conducted on the clinical data, PET/CT, and MRI findings of 17 patients with lymphoma and ONFH. The 18F-FDG uptake of ONFH was recorded, and the maximum standardized uptake value (SUVmax) of ONFH was measured. The staging and extent of ONFH, and other bone involvements, were visually assessed. Lymphoma disease status was evaluated using the Deauville criteria.
RESULTS: A total of 31 femoral heads were involved (2 stage 1, 24 stage 2, 4 stage 3, 1 stage 4). The median SUVmax was higher in stage 3-4 lesions (5.27) than in stage 1-2 lesions (1.37) (P = 0.002). Regarding 18F-FDG uptake patterns, all stage 1 lesions showed normal uptake; among stage 2 lesions, 11 showed increased uptake, 5 showed peripheral increased with central decreased uptake, 2 showed decreased uptake, and 6 showed normal uptake; all stage 3-4 lesions demonstrated increased uptake. On CT, the extent of all stage 2-4 lesions matched MRI findings. Nine patients had osteonecrosis in other bones, including the humeral heads (n = 9), bilateral iliac bones (n = 6), and vertebrae/ribs/scapulae (n = 1).
CONCLUSIONS: In patients with lymphoma, ONFH exhibits variable degrees of 18F-FDG uptake and may be accompanied by involvement of other bones. PET/CT may raise suspicion for ONFH and detect multiple bone involvements during lymphoma assessment.
METHODS: A retrospective analysis was conducted on the clinical data, PET/CT, and MRI findings of 17 patients with lymphoma and ONFH. The 18F-FDG uptake of ONFH was recorded, and the maximum standardized uptake value (SUVmax) of ONFH was measured. The staging and extent of ONFH, and other bone involvements, were visually assessed. Lymphoma disease status was evaluated using the Deauville criteria.
RESULTS: A total of 31 femoral heads were involved (2 stage 1, 24 stage 2, 4 stage 3, 1 stage 4). The median SUVmax was higher in stage 3-4 lesions (5.27) than in stage 1-2 lesions (1.37) (P = 0.002). Regarding 18F-FDG uptake patterns, all stage 1 lesions showed normal uptake; among stage 2 lesions, 11 showed increased uptake, 5 showed peripheral increased with central decreased uptake, 2 showed decreased uptake, and 6 showed normal uptake; all stage 3-4 lesions demonstrated increased uptake. On CT, the extent of all stage 2-4 lesions matched MRI findings. Nine patients had osteonecrosis in other bones, including the humeral heads (n = 9), bilateral iliac bones (n = 6), and vertebrae/ribs/scapulae (n = 1).
CONCLUSIONS: In patients with lymphoma, ONFH exhibits variable degrees of 18F-FDG uptake and may be accompanied by involvement of other bones. PET/CT may raise suspicion for ONFH and detect multiple bone involvements during lymphoma assessment.