Case Author(s): Lester Johnson, M.D., Ph.D. and Farrokh Dehdashti, M.D. , 06/07/00 . Rating: #D2, #Q4

Diagnosis: Bone marrow activation

Brief history:

39-year-old woman with non-Hodgkin's lymphoma


A coronal FDG-PET image is shown

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View second image(pt). A sagittal FDG-PET image is shown

Full history/Diagnosis is available below

Diagnosis: Bone marrow activation

Full history:

This 39-year-old woman has a history of non-Hodgkin's lymphoma. She was treated with chemotherapy ending 2 weeks ago. Her therapy included Nupogen.


15.0 mCi F-18 fluorodeoxyglucose (FDG) i.v.


There is marked diffusely increased metabolic activity throughout the bone marrow. This increased activity is diffuse and homogeneous, consistent with bone marrow activation in a patient recently treated with Nupogen. Please note that sometimes diffuse bone marrow involvement may not distinguishable from therapy with bone marrow stimulating agents such as Nupogen.


Nupogen is a recombinant pharmaceutical form of an endogenous hematopoeitic stimulating factor. Nupogen stimulation of bone marrow allows medical oncologists to treat with higher doses of chemotherapy than would otherwise be possible due to the bone marrow toxicity of chemotherapy. Diffusely increased metabolic activity in the bone marrow may also be seen due to anemia or to bone marrow recovery after chemotherapy, but generally the finding is much milder than that seen within a short time following Nupogen therapy.

Major teaching point(s):

Clinical history will be extremely useful to differentiate between diffuse bone marrow involvement and therapy with bone marrow stimulating agents.

Differential Diagnosis List

Diffuse bone marrow vs.therapy with bone marrow stimulating agents such as Nupogen.

ACR Codes and Keywords:

References and General Discussion of PET Tumor Imaging Studies (Anatomic field:Skeletal System, Category:Metabolic, endocrine, toxic)

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Case number: pt029

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