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18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Management of Aggressive Non-Hodgkin's B-Cell Lymphoma.

Shelly MJ, McDermott S, O'Connor OJ, Blake MA - ISRN Hematol (2012)

Bottom Line: 18-Fluorodeoxyglucose (FDG-PET/CT) is an established imaging modality that has been proven to be of benefit in the management of aggressive B-cell non-Hodgkin's lymphoma, such as diffuse large B-cell lymphoma and advanced stage follicular lymphoma.The combination of anatomic and functional imaging afforded by FDG-PET/CT has led to superior sensitivity and specificity in the primary staging, restaging, and assessment of response to treatment of hematological malignancies when compared to FDG-PET and CT alone.The use of FDG-PET/CT for posttreatment surveillance imaging remains controversial, and further study is needed to ascertain whether this modality is cost effective and appropriate for use in this setting.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.

ABSTRACT
18-Fluorodeoxyglucose (FDG-PET/CT) is an established imaging modality that has been proven to be of benefit in the management of aggressive B-cell non-Hodgkin's lymphoma, such as diffuse large B-cell lymphoma and advanced stage follicular lymphoma. The combination of anatomic and functional imaging afforded by FDG-PET/CT has led to superior sensitivity and specificity in the primary staging, restaging, and assessment of response to treatment of hematological malignancies when compared to FDG-PET and CT alone. The use of FDG-PET/CT for posttreatment surveillance imaging remains controversial, and further study is needed to ascertain whether this modality is cost effective and appropriate for use in this setting.

No MeSH data available.


Related in: MedlinePlus

Coronal CT (a) demonstrating left cervical and right paratracheal lymphadenopathy (white arrows) and mild splenomegaly (white arrowhead) consistent with high-grade follicular lymphoma. Corresponding coronal fused FDG-PET/CT (b) demonstrates increased radiotracer uptake in the pathologically enlarged left cervical and right paratracheal lymphadenopathy (white arrows) and spleen (white arrowhead), but also abnormal FDG accumulation in right cervical and left external iliac lymph nodes (white arrows) that appeared normal by size criteria on the corresponding CT scan. Coronal PET MIP (c) in the same patient demonstrating widespread increased radiotracer uptake throughout the neck, thorax, abdomen, and proximal humeri and femora bilaterally; the widespread bone marrow involvement was not apparent on CT.
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fig3: Coronal CT (a) demonstrating left cervical and right paratracheal lymphadenopathy (white arrows) and mild splenomegaly (white arrowhead) consistent with high-grade follicular lymphoma. Corresponding coronal fused FDG-PET/CT (b) demonstrates increased radiotracer uptake in the pathologically enlarged left cervical and right paratracheal lymphadenopathy (white arrows) and spleen (white arrowhead), but also abnormal FDG accumulation in right cervical and left external iliac lymph nodes (white arrows) that appeared normal by size criteria on the corresponding CT scan. Coronal PET MIP (c) in the same patient demonstrating widespread increased radiotracer uptake throughout the neck, thorax, abdomen, and proximal humeri and femora bilaterally; the widespread bone marrow involvement was not apparent on CT.

Mentions: FDG-PET/CT has been demonstrated in multiple studies to be very sensitive for the detection of nodal and extranodal lymphoma at initial staging of patients prior to commencement of treatment [33–40]. In general, indolent FL is associated with low-grade FDG uptake, whereas more intense FDG accumulation is seen in more aggressive lymphomas, such as DLBCL [41]. In comparison to CT alone, FDG-PET/CT detects additional foci of FDG uptake, presumed to be lymphomatous deposits, in subcentimeter lymph nodes and particularly in extranodal sites such as the liver, spleen, bone marrow, and muscle in patients with DLBCL with an impact on disease stage (usually upstaging) in approximately 15–20% of patients and with an influence on clinical management in approximately 5–15% [33–37, 42]. FDG-PET/CT is more accurate for staging than both FDG-PET and CT alone, with equal sensitivity and better specificity [30]. Pretreatment FDG-PET/CT imaging acts as a baseline study to facilitate comparison to posttreatment scans to assess response to treatment and evaluate RMs for metabolic activity [6, 7]. FDG-PET/CT has been demonstrated to be effective in the detection of focal or multifocal bone marrow infiltration in patients with a negative iliac crest bone marrow biopsy (BMB) [43]. However, it is important to stress that FDG-PET/CT alone is not completely reliable in detecting limited bone marrow involvement by lymphoma, and, hence, it cannot entirely replace BMB in the initial diagnosis of lymphomas of any type as a negative FDG-PET/CT scan cannot definitively outrule involvement of the bone marrow by lymphoma [44] (Figure 3).


18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Management of Aggressive Non-Hodgkin's B-Cell Lymphoma.

Shelly MJ, McDermott S, O'Connor OJ, Blake MA - ISRN Hematol (2012)

Coronal CT (a) demonstrating left cervical and right paratracheal lymphadenopathy (white arrows) and mild splenomegaly (white arrowhead) consistent with high-grade follicular lymphoma. Corresponding coronal fused FDG-PET/CT (b) demonstrates increased radiotracer uptake in the pathologically enlarged left cervical and right paratracheal lymphadenopathy (white arrows) and spleen (white arrowhead), but also abnormal FDG accumulation in right cervical and left external iliac lymph nodes (white arrows) that appeared normal by size criteria on the corresponding CT scan. Coronal PET MIP (c) in the same patient demonstrating widespread increased radiotracer uptake throughout the neck, thorax, abdomen, and proximal humeri and femora bilaterally; the widespread bone marrow involvement was not apparent on CT.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3313577&req=5

fig3: Coronal CT (a) demonstrating left cervical and right paratracheal lymphadenopathy (white arrows) and mild splenomegaly (white arrowhead) consistent with high-grade follicular lymphoma. Corresponding coronal fused FDG-PET/CT (b) demonstrates increased radiotracer uptake in the pathologically enlarged left cervical and right paratracheal lymphadenopathy (white arrows) and spleen (white arrowhead), but also abnormal FDG accumulation in right cervical and left external iliac lymph nodes (white arrows) that appeared normal by size criteria on the corresponding CT scan. Coronal PET MIP (c) in the same patient demonstrating widespread increased radiotracer uptake throughout the neck, thorax, abdomen, and proximal humeri and femora bilaterally; the widespread bone marrow involvement was not apparent on CT.
Mentions: FDG-PET/CT has been demonstrated in multiple studies to be very sensitive for the detection of nodal and extranodal lymphoma at initial staging of patients prior to commencement of treatment [33–40]. In general, indolent FL is associated with low-grade FDG uptake, whereas more intense FDG accumulation is seen in more aggressive lymphomas, such as DLBCL [41]. In comparison to CT alone, FDG-PET/CT detects additional foci of FDG uptake, presumed to be lymphomatous deposits, in subcentimeter lymph nodes and particularly in extranodal sites such as the liver, spleen, bone marrow, and muscle in patients with DLBCL with an impact on disease stage (usually upstaging) in approximately 15–20% of patients and with an influence on clinical management in approximately 5–15% [33–37, 42]. FDG-PET/CT is more accurate for staging than both FDG-PET and CT alone, with equal sensitivity and better specificity [30]. Pretreatment FDG-PET/CT imaging acts as a baseline study to facilitate comparison to posttreatment scans to assess response to treatment and evaluate RMs for metabolic activity [6, 7]. FDG-PET/CT has been demonstrated to be effective in the detection of focal or multifocal bone marrow infiltration in patients with a negative iliac crest bone marrow biopsy (BMB) [43]. However, it is important to stress that FDG-PET/CT alone is not completely reliable in detecting limited bone marrow involvement by lymphoma, and, hence, it cannot entirely replace BMB in the initial diagnosis of lymphomas of any type as a negative FDG-PET/CT scan cannot definitively outrule involvement of the bone marrow by lymphoma [44] (Figure 3).

Bottom Line: 18-Fluorodeoxyglucose (FDG-PET/CT) is an established imaging modality that has been proven to be of benefit in the management of aggressive B-cell non-Hodgkin's lymphoma, such as diffuse large B-cell lymphoma and advanced stage follicular lymphoma.The combination of anatomic and functional imaging afforded by FDG-PET/CT has led to superior sensitivity and specificity in the primary staging, restaging, and assessment of response to treatment of hematological malignancies when compared to FDG-PET and CT alone.The use of FDG-PET/CT for posttreatment surveillance imaging remains controversial, and further study is needed to ascertain whether this modality is cost effective and appropriate for use in this setting.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.

ABSTRACT
18-Fluorodeoxyglucose (FDG-PET/CT) is an established imaging modality that has been proven to be of benefit in the management of aggressive B-cell non-Hodgkin's lymphoma, such as diffuse large B-cell lymphoma and advanced stage follicular lymphoma. The combination of anatomic and functional imaging afforded by FDG-PET/CT has led to superior sensitivity and specificity in the primary staging, restaging, and assessment of response to treatment of hematological malignancies when compared to FDG-PET and CT alone. The use of FDG-PET/CT for posttreatment surveillance imaging remains controversial, and further study is needed to ascertain whether this modality is cost effective and appropriate for use in this setting.

No MeSH data available.


Related in: MedlinePlus