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The utility of 18F-FDG PET/CT in assessing bone marrow involvement and prognosis in newly diagnosed diffuse large B-cell lymphoma Cover

The utility of 18F-FDG PET/CT in assessing bone marrow involvement and prognosis in newly diagnosed diffuse large B-cell lymphoma

Radiology and Oncology
Volume 59 (2025): Issue 4 (December 2025)
By: Chunyan Yang,  Hong Liu,  Furui Duan,  Ximei Wang,  Ping Li and  Dalong Wang  
Open Access
|Dec 2025

Figures & Tables

FIGURE 1.

The initial PET maximum-intensity projection images, and lymph nodes pathology confirmed DLBCL with normal (A), focal increased in the right humerus (B), diffuse increased (C, D).
The initial PET maximum-intensity projection images, and lymph nodes pathology confirmed DLBCL with normal (A), focal increased in the right humerus (B), diffuse increased (C, D).

FIGURE 2.

Distribution of uptake according to bone marrow biopsy (BMB) and PET/CT. **, p = 0.006; ****, p < 0.0001; BLR = the ratio of the maximum standardized uptake values of bone marrow-to-liver; ns = statistically nonsignificant; SUVmax = maximum standardized uptake value of bone marrow
Distribution of uptake according to bone marrow biopsy (BMB) and PET/CT. **, p = 0.006; ****, p < 0.0001; BLR = the ratio of the maximum standardized uptake values of bone marrow-to-liver; ns = statistically nonsignificant; SUVmax = maximum standardized uptake value of bone marrow

FIGURE 3.

Kaplan-Meier curves for progression-free survival (PFS) in total study patients according to Eastern Cooperative Oncology Group performance status (ECOG PS) (A), bone marrow biopsy (BMB) (B), PET/CT (C) and the ratio of the maximum standardized uptake values of bone marrow-to-liver (BLR) groups (D)
Kaplan-Meier curves for progression-free survival (PFS) in total study patients according to Eastern Cooperative Oncology Group performance status (ECOG PS) (A), bone marrow biopsy (BMB) (B), PET/CT (C) and the ratio of the maximum standardized uptake values of bone marrow-to-liver (BLR) groups (D)

Comparison of bone marrow biopsy (BMB) and PET/CT results with bone marrow involvement (BMI)

Baseline characteristics at diagnosis

CharacteristicPET/CTp -valueBMBp-value
(-) (n = 23)(+) (n = 34)(-) (n = 37)(+) (n = 20)
Male, no. (%)11 (47.83)16 (47.06)0.95517 (45.95)10 (50.00)0.770
Leukopenia, no. (%)2 (8.70)6 (17.65)0.5712 (5.41)6 (30.00)0.031
Anaemia, no. (%)4 (17.39)15 (44.12)0.0367 (18.92)12 (60.00)0.002
Thrombocytopenia, no. (%)2 (8.70)8 (23.53)0.2763 (8.11)7 (35.00)0.029
LMR > 3, no. (%)15 (65.22)20 (58.82)0.62726 (70.27)9 (45.00)0.061
NLR > 2.5, no. (%)10 (43.5)21 (61.8)0.17419 (51.40)12 (60.00)0.532
Age > 60 years, no. (%)10 (43.48)20 (58.82)0.25519 (51.35)11 (55.00)0.792
Stage III/IV, no. (%)19 (82.61)29 (85.29)128 (75.68)20 (100)0.043
ECOG PS ≥ 2, no. (%)8 (34.78)14 (41.18)0.62711 (29.73)11 (55.00)0.061
Clinical systemic symptoms, no. (%)21 (91.30)25 (73.53)0.18531 (83.78)15 (75.00)0.652
Biological systemic symptoms, no. (%)11 (47.83)20 (58.82)0.41318 (48.65)13 (65.00)0.237
LDH (+), no. (%)8 (34.78)18 (52.94)0.17715 (40.54)11 (55.00)0.296
IPI score > 2, no. (%)8 (34.78)18 (52.94)0.17712 (32.43)14 (70.00)0.007
Extranodal sites ≥ 26 (26.09)13 (38.24)0.3408 (21.62)11 (55.00)0.011
BMB (+), no. (%)2 (8.70)18 (52.94)< 0.001---
PET (+), no. (%)---16 (43.24)18 (90.00)< 0.001
High level of BLR, no. (%)027 (79.41)< 0.00110 (27.03)17 (85.00)< 0.001
BM SUVmax, median (P25, P75)2.48 (2.12,3.02)4.74 (3.42,9.43)0.0022.78 (2.28,3.55)6.39 (4.47,11.73)0.003

Comparison of bone marrow biopsy (BMB) and PET/CT to detect bone marrow involvement (BMI)

Accuracy (%)Sensitivity (%)Specificity (%)PPV (%)NPV (%)YIkappaAUC
PET/CT (BMB as standard)68.4 (95 CI,76.9–100)56.8 (95 CI, 40.8–72.7)52.9 (95 CI, 36.2–69.7)52.9 (95 CI, 36.2–69.7)91.3 (95 CI, 79.8–100)0.4680.4030.734
PET/CT (BMI as standard)93.0 (95 CI, 92.8–93.2)94.1 (95 CI, 86.2–100)91.3 (95 CI, 79.8–100)94.1 (95 CI, 86.2–100)91.3 (95 CI, 79.8–100)0.8540.8540.927
BMB (BMI as standard)75.4 (95 CI, 74.8–76.1)58.8 (95 CI,42.3–75.4)100 (95 CI,100–100)100 (95 CI,100–100)62.2 (95 CI,46.5–77.8)0.5880.5360.794

Univariate and multivariate Cox analysis of risk factors for progression-free survival (PFS) in 57 patients with diffuse large B-cell lymphoma (DLBCL)

CharacteristicsUnivariableMultivariable
HR (95%CI)p-valueHR (95%CI)p-value
Male0.619 (0.220-1.747)0.365
Leukopenia0.370 (0.049-2.821)0.338
Anaemia1.880 (0.680-5.199)0.224
Thrombocytopenia0.772 (0.174-3.429)0.734
LMR > 30.251 (0.085-0.737)0.012
NLR > 2.52.763 (0.877-8.708)0.083
Age<60 years1.270 (0.458-3.521)0.646
Clinical systemic symptoms1.500 (0.338-6.656)0.594
Biological systemic symptoms0.636 (0.217-1.866)0.410
Stage III or IV1.268 (0.286-5.624)0.755
ECOG PS ≥ 24.368 (1.479-12.896)0.0084.286 (1.422-12.919)0.010
LDH (+)3.856 (1.227-12.122)0.021
Extranodal sites ≥ 23.638 (1.292-10.245)0.014
IPI score<23.110 (1.055-9.163)0.040
BMB (+)3.663 (1.267-10.415)0.016
PET (+)12.850 (1.678-98.407)0.014
High level of BLR10.527 (2.340-47.364)0.00210.518 (2.305-47.986)0.002
BM SUVmax1.021 (0.954-1.093)0.543

Diagnostic performance in all diffuse large B-cell lymphoma (DLBCL) patients

PET/CTTotal
(+)(-)
BMB(+)18220
(-)162137
Total 342357
DOI: https://doi.org/10.2478/raon-2025-0062 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Journal RSS Feed
Language: English
Page range: 488 - 497
Submitted on: Feb 23, 2025
|
Accepted on: Aug 26, 2025
|
Published on: Dec 16, 2025
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
PET/CT,
DLBCL,
bone marrow biopsy,
bone marrow involvement
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 2025 Chunyan Yang, Hong Liu, Furui Duan, Ximei Wang, Ping Li, Dalong Wang, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.

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