Unsuspected ¹⁸F-FDG PET/CT positive findings in the response evaluation or follow-up of non-Hodgkin’s lymphoma patients

Czech version

Authors: T. Papajík ¹; M. Mysliveček ²; Z. Šedová ¹; E. Buriánková ²; V. Procházka ¹; Z. Kubová ¹; Z. Rusiňáková ¹; L. Kučerová ³; M. Tichý ³; D. Starostka ⁴; K. Indrák ¹
Authors‘ workplace: Hemato-onkologická klinika FNOL a LF UP v Olomouci, 2Klinika nukleární medicíny FNOL a LF UP v Olomouci, 3Ústav Patologie FNOL a LF UP v Olomouci, 4Oddělení klinické hematologie Nemocnice Havířov ¹
Published in: Transfuze Hematol. dnes,16, 2010, No. 1, p. 17-24.
Category: Comprehensive Reports, Original Papers, Case Reports

Overview

2-[18F] fluoro-2-deoxy-D-glucose (¹⁸F-FDG) positron emission tomography (PET) is a noninvasive, 3-dimensional imaging modality sufficiently reliable for the diagnosis and initial staging, for the evaluation of therapeutic response and for the detection of recurrence of various types of non-Hodgkin’s lymphoma (NHL). ¹⁸F-FDG is not a tracer absolutely specific for lymphoma and its uptake is increased in various benign conditions or malignancies with enhanced glycolysis. Integrated ¹⁸F-FDG PET/CT systems provide precise localization of the ¹⁸F-FDG-avid lesions and increase sensitivity and specificity of the examination but potential pitfalls and interpretation difficulties still require awareness and close cooperation of radiologist, nuclear medicine physician and hematologist. We report 20 patients with previously treated NHL who presented positive ¹⁸F-FDG PET/CT scans during therapy, at the end of therapy or in suspected recurrence of lymphoma, where unsuspected diagnosis was finally confirmed. 14 patients underwent tissue biopsy and subsequent histopathological evaluation. The final diagnosis was based on analysis of PET/CT scans and follow-up only in 6 patients. Causes of increased ¹⁸F-FDG accumulation: inflammation or infection in 13 patients, tumors in 5 patients (4 benign, 1 malignant) and other diagnoses in 3 patients (thymus hyperplasia in 2 patients, colloid thyreopathy without functional abnormalities in one patient). We suggest that positive findings on ¹⁸F-FDG PET/CT scans during or after therapy in NHL patients must be carefully interpreted by radiologist, nuclear medicine physician and hematologist and in cases of inconclusive results tissue biopsy and histological confirmation should be carried out. Such individual approach may diminish potential diagnostic and therapeutic mistakes.

Key words:
¹⁸F-FDG PET, PET/CT, lymphoma, response evaluation, limitations, pitfalls, unsuspected findings

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