The Netherlands journal of medicine
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In the past decade, 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (18F-FDG PET-CT) scans have been increasingly implemented in the diagnostic process of several haemato-oncological conditions. Accurate assessment of bone marrow activity observed on 18F-FDG PET-CT is crucial for a correct diagnostic conclusion, subsequent treatment decision, and follow-up strategies. By systematically considering the arguments of the level of 18F-FDG uptake, distribution pattern, coinciding changes of the bone structure, and the clinical context, interpretation and validity may improve. This review aims to give a comprehensive overview of the different patterns of 18F-FDG uptake on PET/CT in common benign, clonal, and malignant haematological conditions, accompanied by illustrative cases.
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Monoclonal gammopathy of renal significance (MGRS) includes all kidney disorders caused by a monoclonal protein (M-protein) secreted by a small plasma cell clone or other B-cell clones in patients who do not meet the diagnostic criteria for multiple myeloma or other B-cell malignancies. The underlying disorder in patients with MGRS is generally consistent with monoclonal gammopathy of undetermined significance (MGUS). MGRS-associated kidney disorders are various and the list is still expanding. ⋯ A combined haematologic and nephrologic approach is crucial to establish the causative role of the M-protein in the pathogenesis of kidney disease. Clone-directed therapy, which may include autologous stem cell transplantation in eligible patients, often results in improved outcomes. In this review, we discuss the histopathologic classification of MGRS lesions, provide a renal and haematologic diagnostic workup, discuss treatment options for MGRS, and introduce a Benelux MGRS Working Group.