Increased bone marrow 18F-choline uptake in a patient with hepatocellular carcinoma and thalassemia intermedia.

A 57-year-old male with history of thalassemia intermedia and hepatocellular carcinoma underwent a PET/CT scan with 18F-choline before radioembolization procedure with 90Y-microspheres. 18F-choline demonstrated highly increased tracer incorporation within a gross lesion in the hepatic dome coupled with diffuse activity in bone marrow, this latter aspect probably due to the compensatory hematopoiesis stimulation induced by chronic hemolysis. This pattern of skeletal 18F-choline uptake should be considered as a peculiar PET/CT finding in thalassemic patients.