Physiologically decreased F-18 fluorodeoxyglucose uptake in the lower vertebrae associated with daily drinking habit in Japanese men with alcohol flushing reaction.

Alcohol flushing reaction (AFR) is known as one of risks for esophageal squamous cell cancer and scientists have been elucidating this issue. However, little attention has been given to relevant imaging features. This study aims to investigate whether physiological F-fluorodeoxyglucose (FDG) uptake patterns in vertebrae are associated with drinking-habit or AFR. Japanese male patients who underwent FDG positron emission tomography/computed tomography for evaluation of their known or suspected malignancy or inflammatory disease were asked about their drinking-habit and AFR. Altogether, 192 patients, 139 everyday-drinkers and 53 non-drinkers were evaluated. Comparing the FDG uptake between in the thoracic region and that in the lumbar region, vertebral uptake was visually classified into 4 patterns: Ld, dominant in lumbar region; TL, almost equal in both regions; BL, slightly higher in thoracic region (borderline pattern); Td, dominant in thoracic region. The uptake patterns were evaluated according to drinking-habit (everyday- or non-drinker), AFR (flusher or non-flusher) and the combination of these two factors (habit/reaction: everyday-drinker/flusher, everyday-drinker/non-flusher, non-drinker/flusher, or non-drinker/non-flusher). There were 95 flushers (51 everyday-drinkers and 44 non-drinkers) and 97 non-flushers (88 everyday-drinkers and 9 non-drinkers). Ld, TL, BL, and Td patterns were observed in 0, 109 (56.8%), 31 (16.1%), and 52 (27.1%) patients, respectively. Td and BL patterns were more frequently observed in everyday-drinkers compared with non-drinkers (p = 0.0467). Though the uptake patterns did not differ between in flushers and non-flushers (p = 0.116), Td pattern was more frequently observed in everyday-drinkers/flusher (51%) compared with everyday-drinkers/non-flusher (20.5%), non-drinker/flusher (13.6%), and non-drinker/non-flusher (22.2%) (p = 0.0014). Td pattern was observed in patients with various diseases, with higher frequency in esophageal cancer, head and neck cancer and lung cancer compared with other diseases. In conclusion, drinking-habit and AFR were related to the vertebral uptake pattern with decreased uptake in the lumbar region in Japanese male patients

Predominance and Homogeneity Patterns of Physiological FDG Accumulation in Thoracic and Lumbar Vertebrae: Suspected Mechanism of "Bone Pseudometastasis" on FDG-PET in Japanese Patients With Esophageal Cancer

ObjectiveFalse-positive bone lesions (bone pseudometastases) have been often reported in patients with esophageal cancer (EsoC). This study aimed to evaluate the vertebral 2-deoxy-2-[18F] fluoro-D-glucose (FDG) accumulation pattern in patients with newly diagnosed esophageal cancers and other malignancies (OtherT) to elucidate the possible mechanism that causes bone pseudometastasis.MethodsFDG positron emission tomography/computed tomography performed for 90 patients with EsoC, and 112 patients with OtherT was retrospectively evaluated. The uptake pattern in the thoracic (Th) and lumbar (L) vertebrae was visually assessed regarding predominance (TL, Th ≒ L; Td, Th > L; Ld, L > Th), main intensity compared with the uptake in the blood pool (BP) (Grade 1  BP), and homogeneity (homogeneous, heterogeneous, marginal, or spotty). The patterns between EsoC and OtherT and between Th and L were compared.ResultsTL, Td, and Ld patterns were observed in 51.1%, 48.9%, and 0% in EsoC and 79.7%, 20.3%, and 0% in OtherT. Though Grade 2 was most frequently observed in both groups, the ratio of Grade 3 in Th and Grade 1 in L was significantly higher in EsoC than in OtherT. Heterogeneous and spotty patterns were more frequently observed in L and in EsoC, and these were strongly associated with Td pattern.ConclusionTd pattern was frequently seen, especially in EsoC, and was strongly associated with a heterogeneous or marginal pattern in the L. Heterogeneous marrow distribution with declined lumbar uptake is suspected as the mechanism of bone pseudometastasis