ORIGINAL ARTICLE Role of F-18 FDG PET/CT in assessing bone marrow involvement in pediatric Hodgkin’s lymphoma Kanhaiyalal Agrawal • Bhagwant Rai Mittal • Deepak Bansal • Neelam Varma • Radhika Srinivasan • Amita Trehan • Kuruva Manohar • Raghava Kashyap • Anish Bhattacharya • Ram K. Marwaha Received: 6 August 2012 / Accepted: 29 October 2012 / Published online: 11 November 2012 Ó The Japanese Society of Nuclear Medicine 2012 Abstract Objectives The aim of the current study was to assess the utility of F-18-fluoro-2-deoxy-D-glucose (F-18 FDG) pos- itron emission tomography/computed tomography (PET/ CT) in assessing bone marrow involvement (BMI) com- pared to bone marrow biopsy (BMB) in initial staging of Hodgkin’s lymphoma (HL) in pediatric patients. Methods Data of 38 pediatric patients (mean age 9.8 years, range 3–18 years) with HL were analyzed for the involvement of bone marrow. All patients underwent non- contrast F-18 FDG PET/CT study. BMB was done in 31 patients from the bilateral iliac crests. Scans were inter- preted by two nuclear medicine physicians blinded to the details of BMB. Results Of the 31 patients who underwent BMB, 5 patients had lymphomatous involvement on BMB. PET/CT was positive in four of these five patients. In 26 patients negative on BMB, PET was negative in 23 patients and positive in 3 patients for BMI. The sensitivity and negative predictive value of F-18 FDG PET/CT was 87.5 and 96 %, respectively, for BMI. Conclusions F-18 FDG PET/CT can predict BMB results with high accuracy. F-18 FDG PET/CT may be used at initial staging of pediatric Hodgkin’s lymphoma as it uncovers unsuspected BMI and BMB may be omitted in patients with PET-positive BMI. Keywords Pediatric Hodgkin’s lymphoma Á Bone marrow involvement Á Bone marrow biopsy Á FDG PET/CT Introduction Lymphomas account for 10–15 % of pediatric cancers. In children, 40 % of lymphomas are Hodgkin’s lymphoma (HL) [1, 2]. During preadolescent period mixed cellularity and nodular sclerosis are the two main histopathological subtypes of HL, while adolescents have a predominant incidence of the nodular sclerosis type HL [3]. Therapeutic options for HL are various combinations of chemotherapy and radiotherapy, which depend on the stage of the disease at the time of diagnosis, separating early/localized stages and advanced/disseminated stages [4–6]. This emphasizes the need of adequate staging before initiating a risk-adapted therapy, taking into account the balance between efficacy and risks of toxicity and long-term adverse effects [7]. Staging based on the Ann Arbor classification usually includes computed tomography (CT) and bone marrow biopsy (BMB) [8, 9]. Bone marrow involvement (BMI) upstages the disease to stage IV, which changes both treat- ment and prognosis. BMB is considered as the reference standard for the depiction of BMI [9]. However, this K. Agrawal Á B. R. Mittal (&) Á K. Manohar Á R. Kashyap Á A. Bhattacharya Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India e-mail: brmittal.pgi@gmail.com D. Bansal Á A. Trehan Á R. K. Marwaha Pediatric Hematology/Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India N. Varma Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India R. Srinivasan Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India 123 Ann Nucl Med (2013) 27:146–151 DOI 10.1007/s12149-012-0665-5