The prevalence of extramedullary acute myeloid leukemia detected by 18FDG-PET/CT: final results from the prospective PETAML trial

Haematologica. 2020 Jun;105(6):1552-1558. doi: 10.3324/haematol.2019.223032. Epub 2019 Aug 29.


Extramedullary (EM) disease in patients with acute myeloid leukemia (AML) is a known phenomenon. Since the prevalence of EM AML has so far only been clinically determined on examination, we performed a prospective study in patients with AML. The aim of the study was to determine the prevalence of metabolically active EM AML using total body 18Fluorodesoxy-glucose positron emission tomography/computed tomography (18FDG-PET/CT) imaging at diagnosis prior to initiation of therapy. In order to define the dynamics of EM AML throughout treatment, PET-positive patients underwent a second 18FDG-PET/CT imaging series during follow up by the time of remission assessment. A total of 93 patients with AML underwent 18FDG-PET/CT scans at diagnosis. The prevalence of PET-positive EM AML was 19% with a total of 65 EM AML manifestations and a median number of two EM manifestations per patient (range, 1-12), with a median maximum standardized uptake value of 6.1 (range, 2-51.4). When adding those three patients with histologically confirmed EM AML who were 18FDG-PET/CT negative in the 18FDG-PET/CT at diagnosis, the combined prevalence for EM AML was 22%, resulting in 77% sensitivity and 97% specificity. Importantly, 60% (6 of 10) patients with histologically confirmed EM AML still had active EM disease in their follow up 18FDG-PET/CT. 18FDG-PET/CT reveals a high prevalence of metabolically active EM disease in AML patients. Metabolic activity in EM AML may persist even beyond the time point of hematologic remission, a finding that merits further prospective investigation to explore its prognostic relevance. (Trial registered at identifier: 01278069).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Fluorodeoxyglucose F18*
  • Humans
  • Leukemia, Myeloid, Acute* / diagnostic imaging
  • Leukemia, Myeloid, Acute* / epidemiology
  • Positron Emission Tomography Computed Tomography
  • Positron-Emission Tomography
  • Prevalence
  • Prospective Studies
  • Radiopharmaceuticals
  • Sensitivity and Specificity


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18