Abstract Details

Title 18Fluorodeoxyglucose Positron Emission Tomography Spinal Cord Hypermetabolism Discriminates Neoplastic from Inflammatory Myelopathy

Topic Neuro-oncology

Presentation(s) P06 - (-)

Poster/Presentation
Number 142

Objective

Background BACKGROUND: Spinal cord FDG-PET is a possible tool in assessing myelopathies of uncertain etiology. We hypothesized that FDG-PET hypermetabolism could discriminate neoplastic myelopathies from inflammatory etiologies.

Design/Methods DESIGN/METHODS: We retrospectively identified all Mayo Clinic patients from 1996-2011 with myelopathy due to intramedullary spinal cord lesion where diagnostic FDG-PET was performed. Patients with compressive extramedullary myelopathies, radiation myelopathy or chronic myelopathies with known etiologies were excluded. Fifty-one patients were included (53% female) with a median age of 60 years (range 20-82 years). Patients were dichotomized to neoplastic or non-neurosarcoid inflammatory etiologies. Neurosarcoid myelopathies are known FDG-PET hypermetabolic a priori therefore were analyzed separately. Two radiologists independently assessed FDG-PET for hypermetabolism and maximum standardized uptake values (SUVmax) blinded to the underlying myelopathic etiology.

Results RESULTS: Spinal cord hypermetabolism was more common with neoplastic myelopathy (17/21; 81%) than inflammatory myelopathy (6/24; 25%) (p<0.001). Further, median SUVmax was greater in neoplastic than inflammatory causes of myelopathy (3.3 g/ml vs 1.9 g/ml; p<0.001). Agreement between radiologist's assessments was excellent (?=0.88). Inflammatory myelopathic diagnoses (n=24) were: paraneoplastic 13, autoimmune/other 5, inflammatory demyelinating 4, transverse myelitis 2. Neoplastic diagnoses (n=21) were: intramedullary metastases 12; intramedullary lymphoma/leukemia 7; and primary intramedullary neoplasm 2. Six patients had neurosarcoid myelopathy. FDG-PET hypermetabolism was seen in three patients with neurosarcoid myelopathy (median SUVmax 2.6 g/ml; range, 1.8-12.2).

Conclusions CONCLUSIONS: Spinal cord FDG-PET hypermetabolism is more common in neoplastic myelopathies than in inflammatory myelopathies and may be useful in evaluating myelopathy of uncertain etiology to discriminate neoplastic from inflammatory etiologies.

Authors/Disclosures
Eoin P. Flanagan, MBBCh, FAAN (Mayo Clinic) PRESENTER	The institution of Dr. Flanagan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pharmacy times. The institution of Dr. Flanagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Roche. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Merck. The institution of Dr. Flanagan has received research support from Roche. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has a non-compensated relationship as a Member of medical Advisory Board with The MOG Project that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Journal of The Neurologic Sciences that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Neuroimmunology Reports that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology, Neuroimmunology Neuroinflammation (N2) Journal that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology that is relevant to AAN interests or activities.
	No disclosure on file
	No disclosure on file
Val J. Lowe, MD (Mayo Clinic)	Dr. Lowe has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for AVID Radiopharmaceutical. Dr. Lowe has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai Inc. The institution of Dr. Lowe has received research support from AVID Radiopharmaceuticals.
Jayawant N. Mandrekar, PhD	Dr. Mandrekar has nothing to disclose.
Sean J. Pittock, MD, FAAN (Mayo Clinic Dept of Neurology)	Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche/Genentech. The institution of Dr. Pittock has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from NIH. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received publishing royalties from a publication relating to health care.
Brian P. O'Neill, MD, FAAN (Mayo Clinic)	No disclosure on file
Mark Keegan, MD, FAAN (Mayo Clinic)	Dr. Keegan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Keegan has received publishing royalties from a publication relating to health care. Dr. Keegan has received publishing royalties from a publication relating to health care.

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