FDG uptake of the normal spinal cord in PET/MR imaging

Abstract Background: The lack of visualization of the spinal cord hinders the evaluation of18F Fluoro-deoxy-glucose (FDG) uptake of the spinal cord in PET/CT. By exploiting the capability of MRI to precisely outline the spinal cord, we performed a retrospective study aimed to define normal pattern of spinal cord FDG uptake in PET/MRI.Methods: Forty-one patients with lymphoma without clinical or MRI signs of spinal cord or bone marrow involvement underwent simultaneous PET and MRI acquisition using Siemens Biograph mMR after injection of 3.5 MBq/kg body weight of 18FDG for staging purposes. Using a custom-made software, we placed ROIs of 3 and 9 mm in diameter in spinal cord, lumbar CSF and vertebral marrow that were identified on MRI at 5 levels (C2, C5, T6, T12 and L3). The SUVmax, SUVmean and the SUVmax and SUVmean normalized (NSUVmax and NSUVmean) to the liver were measured. For comparison, the same ROIs were placed in PET-CT images obtained immediately before the PET-MRI acquisition following the same tracer injection.Results: On PET/MRI using the 3 mm ROI the following average (all level excluding L3) spinal cord median (1st and 3rd quartile) values were measured: SUVmean1.68 (1.39 and 1.83), SUVmax1.92 (1.60 and 2.14), NSUVmean1.18 (0.93 and 1.36), NSUVmax1.27 (1.01 and 1.33). Using the 9 mm ROI the corresponding values were: SUVmean1.41 (1.25-1.55), SUVmax2.41 (2.08 and2.61), NSUVmean0.93 (0.79 and 1.04), NSUVmax1.28 (1.02 and 1.39). Using the 3 mm ROI the highest values of PET-MRI SUVmax, SUVmean, NSUVmax and NSUVmean were consistently observed at C5 and the lowest at T6. Using a 9 mm ROI the highest values were consistently observed at C5 and the lowest at T12 or T6. The spinal cord FDG-uptake values correlated with bone marrow uptake at the same level, especially in case of NSUVmax. Comparison with PET-CT data revealed that the average SUVmax and SUVmean of the spinal cord were similar in PET-MRI and PET-CT. However, the average NSUVmax and NSUVmean of the spinal cord were higher (range 21% - 47%) in PET-MRI than in PET-CT.Conclusions: Using a whole-body protocol we defined the maximum and mean FDG uptake of the normal spinal cord in PET/MRI. While the observed values show the expected longitudinal distribution, they appear to be higher than those measured in PET/CT. Normalizing the SUVmax and SUVmean of the spinal cord to the liver radiotracer uptake could help in multi-institutional comparisons and studies.