Original article
Evaluation of physiological FDG uptake in the skeleton in adults: Is it uniformly distributed?
Evaluación de la captación fisiológica de FDG en el esqueleto en adultos: ¿Está uniformemente distribuida?
Mustafa Aras
, Fuat Dede, Tunc Ones, Sabahat Inanır, Tanju Yusuf Erdıl, Halil Turgut Turoglu
Corresponding author
Department of Nuclear Medicine, Marmara University School of Medicine, Istanbul, Turkey
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Physiologic accumulation of excreted FDG in the orthotopic ileal neobladder was confirmed by postvoid MIP images of pelvis (G) (arrow). Focal FDG uptake in the right iliac region was considered to be due to metallic material placed after surgery. However, no other abnormal FDG uptake was observed elsewhere in the body.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Erhamamcı, M. Reyhan, N. Altinkaya" "autores" => array:3 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Erhamamcı" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Reyhan" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Altinkaya" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808914001190?idApp=UINPBA00004N" "url" => "/22538089/0000003300000005/v1_201408200020/S2253808914001190/v1_201408200020/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2253808914001189" "issn" => "22538089" "doi" => "10.1016/j.remnie.2014.08.002" "estado" => "S300" "fechaPublicacion" => "2014-09-01" "aid" => "584" "copyright" => "Elsevier España, S.L.U. and SEMNIM" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2014;33:280-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 351 "formatos" => array:2 [ "HTML" => 227 "PDF" => 124 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "[<span class="elsevierStyleSup">18</span>F]fluorothymidine-positron emission tomography in patients with locally advanced breast cancer under bevacizumab treatment: Usefulness of different quantitative methods of tumor proliferation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "280" "paginaFinal" => "285" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "[<span class="elsevierStyleSup">18</span>F]fluortimidina-PET en pacientes con carcinoma de mama localmente avanzado en tratamiento con bevacizumab: utilidad de diferentes métodos de cuantificación de la proliferación celular" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1167 "Ancho" => 2181 "Tamanyo" => 128565 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">[<span class="elsevierStyleSup">18</span>F]FLT PET scan in the breast tumor before (A) and after (B) a single infusion of bevacizumab. A decrease of the PET parameters was observed: SUV40 from 4.57 to 3.33, SUV50 from 4.35 to 3.52, Ki_LV from 0.109 to 0.078 and Ki_DA from 0.128 to 0.098.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Marti-Climent, I. Dominguez-Prado, M.J. Garcia-Velloso, V. Boni, I. Peñuelas, I. Toledo, J.A. Richter" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Marti-Climent" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Dominguez-Prado" ] 2 => array:2 [ "nombre" => "M.J." "apellidos" => "Garcia-Velloso" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Boni" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "Peñuelas" ] 5 => array:2 [ "nombre" => "I." "apellidos" => "Toledo" ] 6 => array:2 [ "nombre" => "J.A." "apellidos" => "Richter" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808914001189?idApp=UINPBA00004N" "url" => "/22538089/0000003300000005/v1_201408200020/S2253808914001189/v1_201408200020/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Evaluation of physiological FDG uptake in the skeleton in adults: Is it uniformly distributed?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "286" "paginaFinal" => "289" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mustafa Aras, Fuat Dede, Tunc Ones, Sabahat Inanır, Tanju Yusuf Erdıl, Halil Turgut Turoglu" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Mustafa" "apellidos" => "Aras" "email" => array:1 [ 0 => "drmustafa.aras@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Fuat" "apellidos" => "Dede" ] 2 => array:2 [ "nombre" => "Tunc" "apellidos" => "Ones" ] 3 => array:2 [ "nombre" => "Sabahat" "apellidos" => "Inanır" ] 4 => array:2 [ "nombre" => "Tanju Yusuf" "apellidos" => "Erdıl" ] 5 => array:2 [ "nombre" => "Halil Turgut" "apellidos" => "Turoglu" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Nuclear Medicine, Marmara University School of Medicine, Istanbul, Turkey" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de la captación fisiológica de FDG en el esqueleto en adultos: ¿Está uniformemente distribuida?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1840 "Ancho" => 3257 "Tamanyo" => 257118 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The relationship between bone marrow SUVmax and age for both sexes (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.25; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Fluordeoxiglucose (FDG), as a glucose analog, is the most commonly used PET radiopharmaceutical in current nuclear oncology practice.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although it is transported into the cell via the same mechanisms as glucose, it is not further metabolized and entrapped in proportion to the rate of glucose metabolism. FDG is not only used by the tumor cells. Heart, brain and urinary tract are the most apparent sites that physiological FDG activity is readily seen. Apart from these, some of the structures in the body, such as bone marrow, may show variable FDG uptake.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In adult patients, normally no FDG uptake is identified in the bone. However physiological linear uptake in physes and apophyses may be seen in skeletally immature pediatric patients.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> FDG uptake in the bone marrow is generally modest with an SUV of less than 3 and bone marrow activity that is more intense than liver activity is considered as abnormal.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> However, as mentioned above bone marrow uptake is variable and such generalizations may affect the sensitivity and specificity of the examination. The aim of the current study was to investigate the differential physiological FDG biodistribution in different sites of the skeleton.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patient population</span><p id="par0010" class="elsevierStylePara elsevierViewall">A total of 158 cancer patients (100 female, 58 male) referred for initial staging with FDG PET/CT were included in this retrospective study. Several therapeutic interventions (e.g., chemotherapy, radiotherapy, synthetic hematopoietic growth factors, etc.) and pathologic states (e.g., benign and/or malignant hematologic disorders, infection, etc.) were known to affect the physiological bone marrow FDG uptake.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–7</span></a> In our study we screened patients’ hospital records (e.g., previous laboratory tests, radiological examinations, treatment records) to exclude these causes. The patients with history of bone metastases, trauma, benign and/or malignant hematologic disorders were excluded from the study. All the patients had follow-up FDG PET/CT performed within 3 months after the initial scan. Subjects with bone metastases in this follow-up PET/CT were also excluded.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Imaging method</span><p id="par0015" class="elsevierStylePara elsevierViewall">Although oral hydration with glucose-free water was allowed, all patients had fasted for at least 6<span class="elsevierStyleHsp" style=""></span>h before image acquisition. None of them were diabetic and the blood glucose levels that were checked before FDG administration were below 200<span class="elsevierStyleHsp" style=""></span>mg/dL. After I.V. injection of 370<span class="elsevierStyleHsp" style=""></span>MBq (10<span class="elsevierStyleHsp" style=""></span>mCi) of FDG, all patients were asked to rest in a quiet room for 60<span class="elsevierStyleHsp" style=""></span>min. According to our departmental protocol, we use oral but not I.V. contrast agent. Image acquisition was performed using an integrated PET/CT system (Discovery-16 LS, GE Healthcare). PET images were acquired from mid-skull to mid-thigh in 3D-mode and reconstructed in transverse, coronal, and sagittal planes. A low-dose CT scan was performed for attenuation correction and anatomic orientation. After the acquisition, data were transferred to a workstation (Advantage Windows Workstation 4.5, GE Healthcare) for processing and interpretation.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Image analysis</span><p id="par0020" class="elsevierStylePara elsevierViewall">SUVmax of the 24 different locations in the skeleton [the diaphysis and proximal metaphysis of the bilateral humerus and femur, 10th rib, sternum (manubrium and corpus), vertebral column (C3, C5, T3, T7, L1, L3) and bilateral pelvic bones (sacrum and bilateral anterior and posterior parts of the iliac bones and acetabulum)] were obtained by drawing volume of interests (VOI), (irregular, voxel) in each region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Degenerative changes were not included in the VOI. All the values were summed, averaged and compared with each other. The mean skeletal SUVmax for each subject was calculated by averaging the SUVmax values of the aforementioned 24 locations.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Statistical analysis was performed by GraphPad InStat Version 3.00 (GraphPad Software Inc, Sandiego, California, USA). Based on analyzed data, Kruskal–Wallis test (nonparametric ANOVA), the Mann–Whitney <span class="elsevierStyleItalic">U</span>-test, and linear regression analysis were used. A <span class="elsevierStyleItalic">p</span> value less than 0.05 was considered to be statistically significant.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">In a total of 158 cancer patients (female/male, 100/58), (55 breast cancer, 43 colorectal cancer, 37 lung cancer, 5 gastric cancer, 12 larynx cancer, 6 testicular cancer) the mean age (female: 57.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13.8 years, male: 59.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14.4 years, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05) and the mean SUVmax of sum of 24 different locations in the skeleton (female: 2.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4, male: 2.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.3, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05) were similar regardless of gender. When taken together for both sexes, FDG uptake in the skeleton was not uniform (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). While the highest FDG uptake was seen in L3 vertebra (mean SUVmax: 2.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.7), the least glucose metabolism was observed in the diaphysis of the lower extremities (mean SUVmax: 1.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.3). The SUVmax of the bilateral proximal metaphyses of the humeri and femora was significantly higher than the neighboring diaphysis (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). The SUVmax of the manubrium of the sternum was significantly higher than the corpus (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). For pelvic bones, while the highest FDG uptakes were detected in sacrum (mean SUVmax: 2.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.7), the least FDG uptakes were seen in anterior iliac bones (SUVmax: 1.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4), (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). Concerning the vertebral column FDG uptakes were also non-uniform and the SUVmax gradually increases from cervical to lumbar spine (C3-mean SUVmax: 2.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4, L3-mean SUVmax: 2.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.7), (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The mean skeletal SUVmax was decreased by the age in both sexes (<span class="elsevierStyleItalic">r</span>: −0.25, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">The bone marrow is found within the central cavities of axial and long bones.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It constitutes approximately 5% of the total body weight in adults.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The two major components of the bone marrow are red and yellow marrow.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The present study showed that FDG uptake in the skeleton was not uniform. It gradually increased from appendicular to axial skeleton. These findings are compatible with the normal distribution of red marrow. In healthy adults, red marrow predominates in the axial skeleton and proximal ends of the humeri and femurs.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The different FDG uptake patterns in these two types of bone marrow may be explained by their relative cell composition. Although majority of the yellow marrow is filled by fat cells (∼95%), hematopoietic cells are the primary component of the red marrow (∼60%).<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Our study also demonstrated that bone marrow metabolism was gradually decreased by the age. Similar to our results, Inoue et al. and Blebea et al. also found a negative correlation between age and bone marrow FDG uptake.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,12</span></a> This may be explained by the physiological age-related transformation from red to yellow marrow. At birth, the bone marrow is filled by hematopoietic red marrow, then it is gradually replaced by fatty yellow marrow with an approximately 10% decrease in cellularity for each decade of life.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a> The transformation from red to yellow marrow begins in the appendicular skeleton and progresses to the axial skeleton.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,11,15</span></a> In the present study we also observed that the mean SUVmax of the bilateral proximal metaphyses of the humeri and femora was higher than the neighboring diaphysis. This difference can also be attributed to the normal age-related marrow conversion. In long bones, marrow conversion occurs first in the diaphysis, then in the distal metaphyses, and finally in the proximal metaphyses.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> Although the adult pattern of marrow distribution – that is the red marrow is located primarily in the axial skeleton, sternum, ribs, and proximal femora and humeri – is generally reached by the age of 25, marrow conversion also proceeds in adulthood but with a slower rate.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11,15</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">To our knowledge, the physiological FDG uptake in the vertebral column has not been evaluated yet. Our results revealed a gradual increase in SUVmax from cervical to lumbar spine in the vertebral column. In the literature, there are morphological studies with MRI about the marrow composition of the vertebral column.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> However, they could not document a significant difference in terms of marrow distribution and signal intensity patterns in the same individual.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Limitations</span><p id="par0055" class="elsevierStylePara elsevierViewall">In our study all the patients with apparent bone metastasis were excluded from the study. Although we tried to eliminate the probability of bone metastasis by performing a follow-up PET/CT within 3 months after the initial scan we did not know whether or not they had bone metastasis under PET resolution limits at the time of PET/CT imaging. Additionally, although we had included 158 patients, we did not have adequate sample size from all age groups to perform a subgroup analysis. Most of our patients were older than 50 years of age.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusion</span><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion, FDG was not uniformly distributed throughout the skeleton in both sexes. It had a tendency to increase from appendicular to axial skeleton and from cervical to lumbar spine in vertebral column which may be related with the normal distribution of the red marrow. Additionally, the glycolytic metabolism of whole skeleton was gradually decreased by the age in both genders. The awareness of this physiological heterogenous FDG distribution in the skeleton is important for reliably identifying marrow involvement in FDG PET/CT studies.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">All the authors state that there were no conflicts of interest when the manuscript was written.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres362357" "titulo" => array:5 [ 0 => "Abstract" 1 => "Aim" 2 => "Material and Methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec342046" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres362356" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Material y Métodos" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec342047" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patient population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Imaging method" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Image analysis" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Limitations" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusion" ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-10-01" "fechaAceptado" => "2014-03-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec342046" "palabras" => array:5 [ 0 => "Bone marrow" 1 => "Skeleton" 2 => "Glycolytic metabolism" 3 => "FDG" 4 => "PET/CT" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec342047" "palabras" => array:5 [ 0 => "Médula ósea" 1 => "Esqueleto" 2 => "Metabolismo glucolítico" 3 => "FDG" 4 => "PET/TC" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Aim</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to study whether FDG was uniformly distributed throughout the skeleton and whether age and gender affected this biodistribution.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Material and Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 158 patients were included in this retrospective study. None of the patients had received prior treatment that had affected the bone marrow and patients with bone metastases, trauma, benign and/or malignant hematologic disorders were excluded from the study. The SUVmax from the 24 different locations in the skeleton was obtained and all the values were compared with each other.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">FDG uptake in the skeleton was not uniform in both sexes. While the highest FDG uptake was seen in the L3 vertebra, the lowest glucose metabolism was observed in the diaphysis of the femur. Concerning the vertebral column, FDG uptakes were also non-uniform and the SUVmax gradually increased from the cervix to the lumbar spine. The mean skeletal SUVmax was decreased in accordance with age in both genders.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">FDG was not uniformly distributed throughout the skeleton in both sexes. It had a tendency to increase from the appendicular to axial skeleton and from cervical to lumbar spine in the vertebral column that may be related with the normal distribution of the red bone marrow. Additionally, the glycolytic metabolism of the whole skeleton was gradually decreased in accordance with the age in both sexes.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue investigar si la FDG se distribuye uniformemente por todo el esqueleto y si la edad y el género afectan la biodistribución.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Material y Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Un total de 158 pacientes fueron incluidos en este estudio retrospectivo. Ningún paciente había recibido tratamiento previo que afectara a la médula ósea y los pacientes con metástasis óseas, trauma, trastornos hematológicos benignos y/o malignos fueron excluidos del estudio. Se obtuvieron las SUVmáx de las 24 ubicaciones diferentes en el esqueleto y todos los valores se compararon entre sí.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La captación de FDG en el esqueleto no fue uniforme en ambos sexos. Mientras que la captación de FDG más alta se observó en la vértebra L3, el metabolismo de la glucosa más bajo se observó en la diáfisis de los fémures. Con respecto a la columna vertebral, la FDG captación tampoco fue uniforme y la SUVmáx aumentó gradualmente desde la columna cervical a la columna lumbar. La SUVmax media esquelética se redujo según la edad en ambos sexos.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La FDG no se distribuyó de manera uniforme en todo el esqueleto en ambos sexos. Tuvo una tendencia a aumentar desde las extremidades al esqueleto axial y desde la columna cervical a la columna lumbar lo que puede estar relacionado con la distribución normal de la médula ósea roja. Además, el metabolismo glicolítico de todo el esqueleto se redujo gradualmente a medida que avanzaba la edad en ambos sexos.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Data presented previously at the Annual Meeting of The EANM 2011 and published as abstract in the proceeding.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 917 "Ancho" => 1395 "Tamanyo" => 118665 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">(A) Anterior, oblique and lateral (from left to right) maximum intensity projection (MIP) images showed the locations where SUVmax values were obtained. (B) Sagittal fusion PET/CT slice showed how the volume of interests (VOI) were drawn in vertebral column.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 931 "Ancho" => 2229 "Tamanyo" => 91311 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The change in vertebral column FDG uptake in both sexes from cervical to lumbar spine (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1840 "Ancho" => 3257 "Tamanyo" => 257118 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The relationship between bone marrow SUVmax and age for both sexes (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.25; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical applications of (18)F-FDG in oncology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.A. 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| Year/Month | Html | Total | |
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| 2018 February | 1 | 1 | 2 |
| 2018 January | 5 | 1 | 6 |
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| 2017 November | 2 | 1 | 3 |
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| 2016 December | 17 | 5 | 22 |
| 2016 November | 12 | 5 | 17 |
| 2016 October | 17 | 4 | 21 |
| 2016 September | 13 | 3 | 16 |
| 2016 August | 0 | 3 | 3 |
| 2016 July | 0 | 1 | 1 |
| 2016 June | 0 | 3 | 3 |
| 2016 May | 0 | 14 | 14 |
| 2016 April | 0 | 6 | 6 |
| 2016 March | 0 | 9 | 9 |
| 2016 February | 0 | 2 | 2 |
| 2016 January | 3 | 6 | 9 |
| 2015 December | 3 | 3 | 6 |
| 2015 November | 10 | 4 | 14 |
| 2015 October | 15 | 6 | 21 |
| 2015 September | 10 | 4 | 14 |
| 2015 March | 1 | 0 | 1 |
| 2015 February | 1 | 0 | 1 |
Show all
