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FDG Positron Emission Tomography in Patients with Systemic Mastocytosis

Georg Zettinig1, Alexander Becherer1, Monika Szabo1, Martin Uffmann2, Robert Dudczak1, Peter Valent3 and Kurt Kletter1

1 Department of Nuclear Medicine, University of Vienna, Währinger Gürtel 18-20, A-1090 Wien, Austria.
2 Department of Radiology, University of Vienna, A-1090 Wien, Austria.
3 Department of Internal Medicine I, University of Vienna, A-1090 Wien, Austria.



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  		Fig. 1A. —52-year-old woman with aggressive systemic mastocytosis with splenomegaly; biopsy-proven mast cell infiltration of liver; and multiple skeletal mast cell infiltration of pelvis, both femora, spine, ribs, and scapulae. One day before positron emission tomography (PET), pathologic fracture of right femoral neck was diagnosed, leading to right-sided hip replacement 5 days after PET. Histology of femoral head revealed 50% bone marrow infiltration. In this patient, aggressive systemic mastocytosis was associated with chronic myelomonocytic leukemia. Coronal maximum-intensity-projection FDG PET image shows no signs of infiltration in known lesions. However, moderate radiotracer accumulation was present in both proximal humeri (arrows) that was also seen in two other patients and did not show any correlation with other imaging methods.

 


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  		Fig. 1B. —52-year-old woman with aggressive systemic mastocytosis with splenomegaly; biopsy-proven mast cell infiltration of liver; and multiple skeletal mast cell infiltration of pelvis, both femora, spine, ribs, and scapulae. One day before positron emission tomography (PET), pathologic fracture of right femoral neck was diagnosed, leading to right-sided hip replacement 5 days after PET. Histology of femoral head revealed 50% bone marrow infiltration. In this patient, aggressive systemic mastocytosis was associated with chronic myelomonocytic leukemia. Radiographs show inhomogeneous pattern with mixed small osteolytic and osteoblastic areas in pelvis, both femora (B), and spine (C), as typically seen in mast cell infiltration. Note right femoral neck fracture.

 


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  		Fig. 1C. —52-year-old woman with aggressive systemic mastocytosis with splenomegaly; biopsy-proven mast cell infiltration of liver; and multiple skeletal mast cell infiltration of pelvis, both femora, spine, ribs, and scapulae. One day before positron emission tomography (PET), pathologic fracture of right femoral neck was diagnosed, leading to right-sided hip replacement 5 days after PET. Histology of femoral head revealed 50% bone marrow infiltration. In this patient, aggressive systemic mastocytosis was associated with chronic myelomonocytic leukemia. Radiographs show inhomogeneous pattern with mixed small osteolytic and osteoblastic areas in pelvis, both femora (B), and spine (C), as typically seen in mast cell infiltration. Note right femoral neck fracture.

 


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  		Fig. 1D. —52-year-old woman with aggressive systemic mastocytosis with splenomegaly; biopsy-proven mast cell infiltration of liver; and multiple skeletal mast cell infiltration of pelvis, both femora, spine, ribs, and scapulae. One day before positron emission tomography (PET), pathologic fracture of right femoral neck was diagnosed, leading to right-sided hip replacement 5 days after PET. Histology of femoral head revealed 50% bone marrow infiltration. In this patient, aggressive systemic mastocytosis was associated with chronic myelomonocytic leukemia. In comparison with adjacent ribs, radiograph shows only subtle changes in left proximal humerus.

 


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  		Fig. 2A. —53-year-old man with aggressive systemic mastocytosis with splenomegaly, ascites, and biopsy-proven mast cell infiltration of liver, skin, and skeleton. Sagittal gradient-echo T1-weighted MR image (TR/TE, 180/4) of lumbar spine shows hypointense bone marrow compared with intervertebral disks, suggesting deposition of mast cells and partial replacement of fatty marrow.

 


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  		Fig. 2B. —53-year-old man with aggressive systemic mastocytosis with splenomegaly, ascites, and biopsy-proven mast cell infiltration of liver, skin, and skeleton. Sagittal inversion recovery MR image (500/30) shows hyperintense bone marrow indicating replacement of normal fat.

 


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  		Fig. 2C. —53-year-old man with aggressive systemic mastocytosis with splenomegaly, ascites, and biopsy-proven mast cell infiltration of liver, skin, and skeleton. Sagittal FDG positron emission tomography image shows normal radiotracer distribution.

 

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