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Ji X, Dong A, Wang Y. FDG PET/CT in Pancreatic Ductal Adenocarcinoma Arising From a Heterotopic Pancreas of the Pylorus. Clin Nucl Med 2024; 49:e42-e44. [PMID: 37976432 DOI: 10.1097/rlu.0000000000004952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
ABSTRACT Malignant transformation of heterotopic pancreas is extremely rare. We describe FDG PET/CT findings in a case of pancreatic ductal adenocarcinoma arising from a heterotopic pancreas in the submucosa of the pylorus with peripyloric lymph node metastasis and elevated serum carbohydrate antigen 19-9 level. The heterotopic pancreatic adenocarcinoma showed intense FDG uptake, and the peripyloric lymph node metastasis showed mild FDG uptake. This case indicates that heterotopic pancreatic adenocarcinoma should be included in the differential diagnosis of FDG-avid gastric submucosal lesions, especially in patients with elevated serum carbohydrate antigen 19-9 level.
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Affiliation(s)
- Xia Ji
- From the Department of Gastroenterology, The Second Affiliated Hospital, Jiaxing University, Jiaxing, Zhejiang Province
| | - Aisheng Dong
- Department of Nuclear Medicine, Changhai Hospital, Naval Medical University
| | - Yang Wang
- Department of Pathology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
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PET imaging of lymphomas. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00047-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Jayaprakasam VS, Paroder V, Schöder H. Variants and Pitfalls in PET/CT Imaging of Gastrointestinal Cancers. Semin Nucl Med 2021; 51:485-501. [PMID: 33965198 PMCID: PMC8338802 DOI: 10.1053/j.semnuclmed.2021.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the past two decades, PET/CT has become an essential modality in oncology increasingly used in the management of gastrointestinal (GI) cancers. Most PET/CT tracers used in clinical practice show some degree of GI uptake. This uptake is quite variable and knowledge of common patterns of biodistribution of various radiotracers is helpful in clinical practice. 18F-Fluoro-Deoxy-Glucose (FDG) is the most commonly used radiotracer and has quite a variable uptake within the bowel. 68Ga-Prostate specific membrane antigen (PSMA) shows intense uptake within the proximal small bowel loops. 11C-methyl-L-methionine (MET) shows high accumulation within the bowels, which makes it difficult to assess bowel or pelvic diseases. One must also be aware of technical artifacts causing difficulties in interpretations, such as high attenuation oral contrast material within the bowel lumen or misregistration artifact due to patient movements. It is imperative to know the common variants and benign diseases that can mimic malignant pathologies. Intense FDG uptake within the esophagus and stomach may be a normal variant or may be associated with benign conditions such as esophagitis, reflux disease, or gastritis. Metformin can cause diffuse intense uptake throughout the bowel loops. Intense physiologic uptake can also be seen within the anal canal. Segmental bowel uptake can be seen in inflammatory bowel disease, radiation, or medication induced enteritis/colitis or infection. Diagnosis of appendicitis or diverticular disease requires CT correlation, as normal appendix or diverticulum can show intense uptake. Certain malignant pathologies are known to have only low FDG uptake, such as early-stage esophageal adenocarcinoma, mucinous tumors, indolent lymphomas, and multicystic mesotheliomas. Response assessment, particularly in the neoadjuvant setting, can be limited by post-treatment inflammatory changes. Post-operative complications such as abscess or fistula formation can also show intense uptake and may obscure underlying malignant pathology. In the absence of clinical suspicion or rising tumor marker, the role of FDG PET/CT in routine surveillance of patients with GI malignancy is not clear.
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Affiliation(s)
- Vetri Sudar Jayaprakasam
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Viktoriya Paroder
- Body Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heiko Schöder
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
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Bonde A, Daly S, Kirsten J, Kondapaneni S, Mellnick V, Menias CO, Katabathina VS. Human Gut Microbiota-associated Gastrointestinal Malignancies: A Comprehensive Review. Radiographics 2021; 41:1103-1122. [PMID: 33989072 DOI: 10.1148/rg.2021200168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The human gastrointestinal tract houses trillions of microbes. The gut and various types of microorganisms, including bacteria, viruses, fungi, and archaea, form a complex ecosystem known as the gut microbiota, and the whole genome of the gut microbiota is referred to as the gut microbiome. The gut microbiota is essential for homeostasis and the overall well-being of a person and is increasingly considered an adjunct "virtual organ," with a complexity level comparable to that of the other organ systems. The gut microbiota plays an essential role in nutrition, local mucosal homeostasis, inflammation, and the mucosal immune system. An imbalanced state of the gut microbiota, known as dysbiosis, can predispose to development of various gastrointestinal malignancies through three speculated pathogenic mechanisms: (a) direct cytotoxic effects with damage to the host DNA, (b) disproportionate proinflammatory signaling inducing inflammation, and (c) activation of tumorigenic pathways or suppression of tumor-suppressing pathways. Several microorganisms, including Helicobacter pylori, Epstein-Barr virus, human papillomavirus, Mycoplasma species, Escherichia coli, and Streptococcus bovis, are associated with gastrointestinal malignancies such as esophageal adenocarcinoma, gastric adenocarcinoma, gastric mucosa-associated lymphoid tissue lymphoma, colorectal adenocarcinoma, and anal squamous cell carcinoma. Imaging plays a pivotal role in diagnosis and management of microbiota-associated gastrointestinal malignancies. Appropriate use of probiotics, fecal microbiota transplantation, and overall promotion of the healthy gut are ongoing areas of research for prevention and treatment of malignancies. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Apurva Bonde
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., S.D., J.K., V.S.K.); University of Texas at Austin, Austin, Tex (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Sean Daly
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., S.D., J.K., V.S.K.); University of Texas at Austin, Austin, Tex (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Julia Kirsten
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., S.D., J.K., V.S.K.); University of Texas at Austin, Austin, Tex (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Sainath Kondapaneni
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., S.D., J.K., V.S.K.); University of Texas at Austin, Austin, Tex (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Vincent Mellnick
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., S.D., J.K., V.S.K.); University of Texas at Austin, Austin, Tex (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Christine O Menias
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., S.D., J.K., V.S.K.); University of Texas at Austin, Austin, Tex (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Venkata S Katabathina
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., S.D., J.K., V.S.K.); University of Texas at Austin, Austin, Tex (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
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Prognostic Impact of Pretreatment 2-[ 18F]-FDG PET/CT Parameters in Primary Gastric DLBCL. ACTA ACUST UNITED AC 2021; 57:medicina57050498. [PMID: 34069203 PMCID: PMC8156603 DOI: 10.3390/medicina57050498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 01/12/2023]
Abstract
Background and Objectives: Primary gastric diffuse large-B cell lymphoma (DLBCL) is an aggressive lymphoma subtype with high 18F-FDG avidity but unclear criteria for 2-[18F]-FDG PET/CT in the evaluation of treatment response and prognostication. Our aim was to investigate whether the pretreatment 2-[18F]-FDG PET/CT variables may predict treatment response (at end of first-line therapy) and prognosis in primary gastric DLBCL. Materials and Methods: we included 57 patients with a diagnosis of primary gastric DLBCL and a baseline 2-[18F]-FDG PET/CT and an end of treatment PET/CT after 6 cycles of R-CHOP chemotherapy. We analyzed PET images qualitatively and semi-quantitatively by deriving the maximum standardized uptake value body weight (SUVbw), the maximum standardized uptake value lean body mass (SUVlbm), the maximum standardized uptake value body surface area (SUVbsa), lesion to liver SUVmax ratio (L-L SUV R), lesion to blood-pool SUVmax ratio (L-BP SUV R), metabolic tumor volume and total lesion glycolysis of gastric lesion (gMTV and gTLG), and total MTV (tMTV) and TLG. Survival curves were plotted according to the Kaplan–Meier analysis. Results: at a median follow up of 80 months, the median PFS and OS were 69 and 80 months. Baseline gMTV, gTLG, tMTV, and TLG were significantly higher in patients with incomplete response (partial response and progression) compared to complete response group. tMTV and TLG were confirmed to be independent prognostic factors both for PFS (p = 0.023 and p = 0.038) and OS (p = 0.038 and p = 0.026); instead, the other metabolic parameters were not related to outcome survival. Conclusions: high tMTV and TLG were significantly correlated with shorter survival (PFS and OS) and may predict incomplete response after therapy.
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Hong GS, Chae EJ, Ryu JS, Chae SY, Lee HS, Yoon DH, Suh C. Assessment of naive indolent lymphoma using whole-body diffusion-weighted imaging and T2-weighted MRI: results of a prospective study in 30 patients. Cancer Imaging 2021; 21:5. [PMID: 33413685 PMCID: PMC7791993 DOI: 10.1186/s40644-020-00371-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/11/2020] [Indexed: 01/05/2023] Open
Abstract
Background We prospectively evaluated the diagnostic utility of whole-body diffusion-weighted imaging with background body signal suppression and T2-weighted short-tau inversion recovery MRI (WB-DWIBS/STIR) for the pretherapeutic staging of indolent lymphoma in 30 patients. Methods This prospective study included 30 treatment-naive patients with indolent lymphomas who underwent WB-DWIBS/STIR and conventional imaging workup plus biopsy. The pretherapeutic staging agreement, sensitivity, and specificity of WB-DWIBS/STIR were investigated with reference to the multimodality and multidisciplinary consensus review for nodal and extranodal lesions excluding bone marrow. Results In the pretherapeutic staging, WB-DWIBS/STIR showed very good agreement (κ = 0.96; confidence interval [CI], 0.88–1.00), high sensitivity (93.4–95.1%), and high specificity (99.0–99.4%) for the whole-body regions. These results were similar to those of 18F-FDG-PET/CT, except for the sensitivity for extranodal lesions. For extranodal lesions, WB-DWIBS/STIR showed higher sensitivity compared to 18F-FDG-PET/CT for the whole-body regions (94.9–96.8% vs. 79.6–86.3%, P = 0.058). Conclusion WB-DWIBS/STIR is an effective modality for the pretherapeutic staging of indolent lymphoma, and it has benefits when evaluating extranodal lesions, compared with 18F-FDG-PET/CT.
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Affiliation(s)
- Gil-Sun Hong
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
| | - Eun Jin Chae
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea.
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
| | - Sun Young Chae
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
| | - Hyo Sang Lee
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, 38, Bangdong-gil, Sacheon-myeon, Gangneung, South Korea
| | - Dok Hyun Yoon
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
| | - Cheolwon Suh
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
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Meng J, Pan H, Li X, Liu T, Liu Z, Li Q, Xiao Y, Liu X, Wu G, Zhu F, Zhang L. Diagnosis and Treatment of Synchronous Lymphoma and Digestive System Carcinoma: Report of Four Cases and Literature Review. Front Oncol 2019; 9:1367. [PMID: 31921632 PMCID: PMC6914839 DOI: 10.3389/fonc.2019.01367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/19/2019] [Indexed: 12/21/2022] Open
Abstract
Objective: To investigate the diagnosis and treatment of synchronous lymphoma and digestive system carcinoma and review literature. Materials and Methods: We retrospectively analyzed the clinical data of four cases of synchronous lymphoma and digestive system carcinoma treated at our hospital. The clinical manifestations, pathological results, and treatment strategies were investigated. Results: One of the four cases was diagnosed as follicular lymphoma with gastric adenocarcinoma, and the other three were diagnosed as diffuse large B-cell lymphoma with digestive system adenocarcinoma in the liver, sigmoid colon, and duodenum papilla, respectively. The second carcinoma was initially discovered incidentally because of the stage examination of lymphoma or the patient's poor response to treatment. The diagnosis of synchronous lymphoma and digestive system carcinoma depended mainly on the pathological examination. Conclusions: The accurate diagnosis of synchronous malignancies is challenging because they rarely occur. We suggest a scrupulous re-biopsy of extranodal lesions in patients with lymphoma to improve the diagnostic accuracy of related double primary tumors. Age, performance status, symptoms, pathological types, and tumor staging should be considered when formulating a treatment strategy. The systemic treatment regimens should include drugs targeting the synchronous tumors in question, and these remain to be explored further.
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Affiliation(s)
- Jingshu Meng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huaxiong Pan
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoqian Li
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Liu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zijian Liu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiuhui Li
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yin Xiao
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinxiu Liu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Zhu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liling Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Albano D, Durmo R, Treglia G, Giubbini R, Bertagna F. 18F-FDG PET/CT or PET Role in MALT Lymphoma: An Open Issue not Yet Solved-A Critical Review. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:137-146. [PMID: 32029397 DOI: 10.1016/j.clml.2019.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 12/12/2022]
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma involves the mucosa-associated lymphoid tissue potentially arising from any mucosal site, with the stomach as the most common site of involvement. MALT lymphoma is not usually an aggressive disease with a good prognosis except for selected cases. Fluorine-18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is a noninvasive imaging tool used for staging, restaging, and evaluation of the treatment response in non-Hodgkin and Hodgkin lymphoma. However, its effective role in MALT lymphoma is not yet clear. The open question is whether these lymphomas are 18F-FDG avid or not, with conflicting results reported in the literature. Consequently, the possible clinical role of 18F-FDG PET/CT for staging and restaging purposes is under debate. The aim of the present review was to analyze the reported data about the role of 18F-FDG PET or PET/CT in patients with MALT lymphoma. We performed a comprehensive computer literature search of the Scopus, Cochrane, PubMed/MEDLINE, and Embase databases, including articles reported up to August 2019. We included 32 studies that had analyzed 18F-FDG PET or PET/CT for patients with MALT lymphoma. We analyzed the metabolic behavior of MALT lymphoma using 18F-FDG PET and the effect of the PET findings in the staging, treatment response evaluation, and prognosis.
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Affiliation(s)
- Domenico Albano
- Department of Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy.
| | - Rexhep Durmo
- Department of Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | - Giorgio Treglia
- Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland; Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Raffaele Giubbini
- Department of Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | - Francesco Bertagna
- Department of Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
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Abstract
BACKGROUND Extranodal manifestations occur in up to 40% of non-Hodgkin lymphomas. The prevalence of extranodal involvement has increased. OBJECTIVES A comprehensive overview on lymphoma involvement in the parenchymatous abdominal organs, the gastrointestinal tract, and the peritoneal cavity under due consideration of clinical implications is given. MATERIALS AND METHODS A selective literature search with analysis of dedicated original research articles and reviews was carried out. Clinical guidelines are discussed. RESULTS Extranodal abdominal lymphoma involvement usually occurs secondarily in advanced disease. Sites involved most frequently are the liver and the gastrointestinal tract. Extranodal abdominal lymphoma involvement is more common in the immunocompromised patient. CONCLUSION Imaging findings of extranodal abdominal lymphoma are variable. Lymphoma is an important differential diagnosis to be considered in unclear tumor diseases.
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Affiliation(s)
- T F Weber
- Radiologische Klinik, Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
| | - S Dietrich
- Medizinische Klinik, Abteilung Innere Medizin V, Hämatologie, Onkologie und Rheumatologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
| | - J Nattenmüller
- Radiologische Klinik, Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
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Uptake of [ 18F]fluorodeoxyglucose in initial positron-emission tomography predicts survival in MALT lymphoma. Blood Adv 2019; 2:649-655. [PMID: 29563121 DOI: 10.1182/bloodadvances.2017013698] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/16/2018] [Indexed: 12/27/2022] Open
Abstract
The role of [18F]fluorodeoxyglucose (FDG) positron-emission tomography (PET) in mucosa-associated lymphoid tissue (MALT) of marginal zone lymphoma remains poorly defined. We correlated initial PET with pathology, clinical factors, and outcome. From January 2001 to July 2012, 173 MALT lymphoma patients with a biopsied lesion identified on PET within 90 days of tissue biopsy were analyzed. PET positivity and intensity of FDG uptake were correlated with clinical factors and patient outcome. Among 173 accrued cases, biopsied site was PET avid in 123 patients (71%); median standardized uptake value (SUV) was 6.0 (range: 0.7-28.0), and SUV >10.0 in 20 patients (16%). PET avidity varied by organ sites. PET positivity correlated with higher International Prognostic Index, but not with 5-year overall survival (OS; 96% vs 88%, PET negative vs positive, P = .229) or 5-year progression-free survival (67% vs 56%, P = .493). SUV was an independent prognostic factor of OS, and an increased SUV was associated with a decreasing 5-year OS. Patients who presented with SUV ≥10 had a higher rate of subsequent large cell transformation (20% vs 5%, P = .035) and inferior OS (78% vs 92%, P = .008). The exact role of FDG PET in the management of MALT lymphoma, beyond initial staging, remains to be defined.
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Wang D, Huo Y, Chen S, Wang H, Ding Y, Zhu X, Ma C. Whole-body MRI versus 18F-FDG PET/CT for pretherapeutic assessment and staging of lymphoma: a meta-analysis. Onco Targets Ther 2018; 11:3597-3608. [PMID: 29950864 PMCID: PMC6016278 DOI: 10.2147/ott.s148189] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is the reference standard in staging of 18F-FDG-avid lymphomas; however, there is no recommended functional imaging modality for indolent lymphomas. Therefore, we aimed to compare the performance of whole-body magnetic resonance imaging (WB-MRI) with that of 18F-FDG PET/CT for lesion detection and initial staging in patients with aggressive or indolent lymphoma. Materials and methods We searched the MEDLINE, EMBASE, and CENTRAL databases for studies that compared WB-MRI with 18F-FDG PET/CT for lymphoma staging or lesion detection. The methodological quality of the studies was assessed using version 2 of the “Quality Assessment of Diagnostic Accuracy Studies” tool. The pooled staging accuracy (μ) of WB-MRI and 18F-FDG PET/CT for initial staging and for assessing possible heterogeneity (χ2) across studies were calculated using commercially available software. Results Eight studies comprising 338 patients were included. In terms of staging, the meta-analytic staging accuracies of WB-MRI and 18F-FDG PET/CT for Hodgkin lymphoma and aggressive non-Hodgkin lymphoma (NHL) were 98% (95% CI, 94%–100%) and 98% (95% CI, 94%–100%), respectively. The pooled staging accuracy of 18F-FDG PET/CT dropped to 87% (95% CI, 72%–97%) for staging in patients with indolent lymphoma, whereas that of WB-MRI remained 96% (95% CI, 91%–100%). Subgroup analysis indicated an even lower staging accuracy of 18F-FDG PET/CT for staging of less FDG-avid indolent NHLs (60%; 95% CI, 23%–92%), in contrast to the superior performance of WB-MRI (98%; 95% CI, 88%–100%). Conclusion WB-MRI is a promising radiation-free imaging technique that may serve as a viable alternative to 18F-FDG PET/CT for staging of 18FDG-avid lymphomas, where 18F-FDG PET/CT remains the standard of care. Additionally, WB-MRI seems a less histology-dependent functional imaging test than 18F-FDG PET/CT and may be the imaging test of choice for staging of indolent NHLs with low 18F-FDG avidity.
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Affiliation(s)
- Danyang Wang
- Department of Nuclear Medicine, Affiliated XinHua Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yanlei Huo
- Department of Nuclear Medicine, Affiliated XinHua Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Suyun Chen
- Department of Nuclear Medicine, Affiliated XinHua Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hui Wang
- Department of Nuclear Medicine, Affiliated XinHua Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yingli Ding
- Department of Nuclear Medicine, Affiliated Third People's Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaochun Zhu
- Department of Nuclear Medicine, Affiliated Ninth People's Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chao Ma
- Department of Nuclear Medicine, Affiliated XinHua Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Nuclear Medicine, Tenth People's Hospital of Tongji University, Shanghai, China
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Salvatore B, Fonti R, De Renzo A, Pellegrino S, Ferrara IL, Mainolfi CG, Marano L, Selleri C, Pane F, Del Vecchio S, Pace L. 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography in primary extranodal lymphomas: treatment response evaluation and prognosis. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 64:219-225. [PMID: 29697219 DOI: 10.23736/s1824-4785.18.03043-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We evaluated the role of [18F]FDG PET/CT in tumor response assessment and prognosis of primary extranodal lymphoma (PEL) patients. METHODS We examined retrospectively, 56 PEL patients: 31 with aggressive diffuse large B cell lymphoma (DLBCL) and 25 with indolent lymphoma (20 mucosa-associated lymphoid tissue lymphoma and five follicular lymphoma). All patients had undergone [18F]FDG PET/CT at diagnosis (PET-I) and 50 of them also after therapy (PET-II). Moreover, 52 patients were subjected to a mean follow-up period of 76 months. RESULTS PET-I was positive in 50 (89%) patients (mean SUVmax 10.3±6.7). In the assessment of tumor response, according to Lugano classification, 45 patients showed complete metabolic response (CMR), four patients had partial metabolic response (PMR) and one had progressive metabolic disease (PMD). Based on 66% ΔSUVmax cut-off, among CMR patients, 41 showed a ΔSUVmax>66% whereas among non-responders, four patients showed a ΔSUVmax<66%. At follow-up, univariate analysis showed that age, performance status, prognostic index, ΔSUVmax and Lugano classification predicted progression-free survival (PFS) (P<0.05), while, performance status, prognostic index, ΔSUVmax and Lugano classification predicted overall survival (OS) (P<0.05). At multivariate analysis only Lugano classification was retained in the model for prediction of both PFS (P<0.05) and OS (P<0.05). By Kaplan-Meier analysis and log-rank testing both PFS and OS were significantly better in patients in CMR as compared to patients in PMR or PMD according to Lugano classification (P<0.01). CONCLUSIONS [18F]FDG PET/CT represents a useful tool in the detection of disease response and in the evaluation of outcome in PEL patients.
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Affiliation(s)
- Barbara Salvatore
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy
| | - Rosa Fonti
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy -
| | - Amalia De Renzo
- Department of Surgery and Clinical Medicine, Federico II University, Naples, Italy
| | - Sara Pellegrino
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Ida L Ferrara
- Scuola Medica Salernitana Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Ciro G Mainolfi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Luana Marano
- Department of Surgery and Clinical Medicine, Federico II University, Naples, Italy
| | - Carmine Selleri
- Scuola Medica Salernitana Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Fabrizio Pane
- Department of Surgery and Clinical Medicine, Federico II University, Naples, Italy
| | - Silvana Del Vecchio
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Leonardo Pace
- Scuola Medica Salernitana Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
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Ramos CA. Marginal Zone Lymphomas (Extranodal/Malt, Splenic, and Nodal). Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00079-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Alagöz E, Okuyucu K, İnce S, Kantarcıoğlu M, Özaydın Ş, Heper C, Türker T, Arslan N. Uptake Patterns of Untreated Primary Gastrointestinal Extranodal Lymphomas on Initial Staging 18F-FDG PET/CT and Metabolic Tumor Parameters. Mol Imaging Radionucl Ther 2017; 26:83-92. [PMID: 28976330 PMCID: PMC5643944 DOI: 10.4274/mirt.48658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: Non-Hodgkin’s lymphomas arising from tissues other than primary lymphatic sites are classified as primary extranodal lymphomas (PEL). PELs of the gastrointestinal system (PGISL) originate from the lymphatic tissues within the gastrointestinal tract. The prognostic value of 18F-FDG PET/CT in lymphomas is high in terms of both overall survival (OS) and disease-free survival (DFS). Our aim was to investigate the uptake patterns and properties of low-grade and high-grade PGISL on primary staging 18F-FDG PET/CT, as well as the prognostic significance of metabolic tumor parameters in high grade PGISL. Methods: Thirty-nine patients with PGISL were enrolled in this retrospective cohort study between 2004-2015. Primary staging 18F-FDG PET/CT have been performed and quantitative parameters of SUVmax, SUVmean, metabolic tumor volume (MTV), total lesion glycolysis (TLG) have been calculated for all patients prior to treatment. Low-grade and high-grade PGISL were compared in terms of metabolic tumor parameters. Cox regression models were performed to determine factors that correlate with DFS in high-grade PGISL. Results: There were statistically significant differences between high-grade and low-grade PGISL in terms of SUVmax, SUVmean, MTV, TLG, recurrence, mortality, DFS and OS. None of the potential risk factors (sex, age, site, SUVmax, SUVmean, MTV, TLG) for recurrence and metastasis in high grade PGISL was identified as a risk factor on univariate and multivariate Cox regression analysis. Conclusion: Metabolic tumor parameters are not predictive markers in high-grade PGISL, especially in diffuse large B cell variant and primary gastric lymphoma. The first implications suggest they will not play a role in patient management.
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Affiliation(s)
- Engin Alagöz
- Gülhane Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
| | - Kürşat Okuyucu
- Gülhane Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
| | - Semra İnce
- Gülhane Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
| | - Murat Kantarcıoğlu
- Gülhane Training and Research Hospital, Clinic of Gastroenterology, Ankara, Turkey
| | - Şükrü Özaydın
- Gülhane Training and Research Hospital, Clinic of Medical Oncology, Ankara, Turkey
| | - Cumhur Heper
- İstanbul University Institute of Cardiology, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Türker Türker
- Gülhane Training and Research Hospital, Clinic of Public Health, Ankara, Turkey
| | - Nuri Arslan
- Gülhane Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
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Abstract
Gastric cancer is a disease with low survival rates and high morbidity, requiring accurate and prompt diagnosis and treatment. Although limited in the evaluation of the primary tumor as such, the metabolic information of primary tumors in an 18F-FDG PET/CT study can assist in surgical and treatment planning and differentiating gastric cancers. It detects nodal disease with good specificity and positive predictive value, thus enabling appropriate therapy for individual patients. It provides valuable information about distant metastases, altering therapy decisions. It has reasonably good performance in detecting recurrent disease and in the follow-up of patients.
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17
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Extranodal lymphomas of abdomen and pelvis: imaging findings and differential diagnosis. Abdom Radiol (NY) 2017; 42:1096-1112. [PMID: 27866240 DOI: 10.1007/s00261-016-0964-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A wide spectrum of extranodal lymphomas in the abdomen and pelvis is commonly encountered by imaging. Diagnosing these lesions generally requires a multimodality approach. This review highlights imaging appearances of extranodal lymphomas in the abdomen and pelvis with emphasis on computed tomography, magnetic resonance imaging, and positron emission tomography-computed tomography along with the relevant differential diagnosis.
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Prognostic value of SUVmax measured by pretreatment 18F-FDG PET/CT in patients with primary gastric lymphoma. Nucl Med Commun 2017; 37:1267-1272. [PMID: 27482643 DOI: 10.1097/mnm.0000000000000579] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of this retrospective study was to determine whether glucose metabolism assessed by fluorine-18 fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) provides prognostic information independent of established prognostic factors in patients with gastric lymphoma. PATIENTS AND METHODS We reviewed the medical records of 86 patients retrospectively (men, 42; women, 44; mean age 58±13 years) with pathologically proven gastric lymphoma (34 mucosa-associated lymphoid tissue and 52 aggressive non-Hodgkin's lymphoma). They underwent F-FDG PET/CT as part of a pretreatment work-up from February 2004 to July 2012. For the analysis, patients were classified by age, sex, Musshoff stage, serum lactate dehydrogenase, International Prognostic Index score, extragastric spread, and visual intensity [visual assessment and maximum standardized uptake value (SUVmax), respectively]. The relationship between F-FDG uptake and survival was analyzed using the Kaplan-Meier method with a log-rank test and Cox's proportional-hazard regression method. RESULTS The median survival of all 86 study participants was 1117 days and the median SUV measured by PET/CT was 6.1 (range, 1.9-32.7). Patients with an SUVmax less than or equal to 5.2 survived significantly longer than patients with an SUVmax more than 5.2 (median, 1163 vs. 1004 days; P=0.003). Survival was also found to be significantly related to age (P=0.0005), histological type (P=0.004), extragastric spread (P=0.0004), International Prognostic Index score (P<0.0001), serum lactate dehydrogenase (P=0.02), stage (P<0.0001), and visual intensity (P=0.041). A multivariate analysis showed that patients with a higher SUVmax [P=0.021; 95% confidence interval (CI), 1.52-8.14; hazard ratio (HR)=6.29], older age (P=0.001; 95% CI, 4.64-219.96; HR=18.8), more aggressive histologic type (P=0.006; 95% CI, 2.20-70.63; HR=12.76), and higher stage (P=0.0006; 95% CI, 5.81-206.43; HR=17.48) showed worse survival. CONCLUSION A higher SUVmax on pretreatment F-FDG PET/CT can predict poorer survival in patients with gastric lymphoma.
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Albano D, Bosio G, Giubbini R, Bertagna F. 18F-FDG PET/CT and extragastric MALT lymphoma: role of Ki-67 score and plasmacytic differentiation. Leuk Lymphoma 2017; 58:2328-2334. [DOI: 10.1080/10428194.2017.1298754] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Domenico Albano
- Nuclear Medicine, Spedali Civili Brescia, University of Brescia, Brescia, Italy
| | - Giovanni Bosio
- Nuclear Medicine, Spedali Civili Brescia, University of Brescia, Brescia, Italy
| | - Raffaele Giubbini
- Nuclear Medicine, Spedali Civili Brescia, University of Brescia, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, Spedali Civili Brescia, University of Brescia, Brescia, Italy
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Nagpal P, Prakash A, Pradhan G, Vidholia A, Nagpal N, Saboo SS, Kuehn DM, Khandelwal A. MDCT imaging of the stomach: advances and applications. Br J Radiol 2016; 90:20160412. [PMID: 27785936 DOI: 10.1259/bjr.20160412] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The stomach may be involved by a myriad of pathologies ranging from benign aetiologies like inflammation to malignant aetiologies like carcinoma or lymphoma. Multidetector CT (MDCT) of the stomach is the first-line imaging for patients with suspected gastric pathologies. Conventionally, CT imaging had the advantage of simultaneous detection of the mural and extramural disease extent, but advances in MDCT have allowed mucosal assessment by virtual endoscopy (VE). Also, better three-dimensional (3D) post-processing techniques have enabled more robust and accurate pre-operative planning in patients undergoing gastrectomy and even predict the response to surgery for patients undergoing laparoscopic sleeve gastrectomy for weight loss. The ability of CT to obtain stomach volume (for bariatric surgery patients) and 3D VE images depends on various patient and protocol factors that are important for a radiologist to understand. We review the appropriate CT imaging protocol in the patients with suspected gastric pathologies and highlight the imaging pearls of various gastric pathologies on CT and VE.
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Affiliation(s)
- Prashant Nagpal
- 1 Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,2 Department of Radiodiagnosis, Lok Nayak Jai Prakash Hospital, Maulana Azad Medical College, Delhi, India
| | - Anjali Prakash
- 2 Department of Radiodiagnosis, Lok Nayak Jai Prakash Hospital, Maulana Azad Medical College, Delhi, India
| | - Gaurav Pradhan
- 2 Department of Radiodiagnosis, Lok Nayak Jai Prakash Hospital, Maulana Azad Medical College, Delhi, India
| | - Aditi Vidholia
- 3 Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Nishant Nagpal
- 4 Department of Gastroenterology, Fortis Flt. Lt. Rajan Dhall Hospital, Delhi, India
| | - Sachin S Saboo
- 5 Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, TX, USA
| | - David M Kuehn
- 1 Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Li XF, Fu Q, Dong YW, Liu JJ, Song XY, Dai D, Zuo C, Xu WG. 18F-fluorodeoxyglucose positron emission tomography/computed tomography comparison of gastric lymphoma and gastric carcinoma. World J Gastroenterol 2016; 22:7787-7796. [PMID: 27678362 PMCID: PMC5016379 DOI: 10.3748/wjg.v22.i34.7787] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/20/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To compare 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) features in gastric lymphoma and gastric carcinoma.
METHODS Patients with newly diagnosed gastric lymphoma or gastric carcinoma who underwent 18F-FDG PET/CT prior to treatment were included in this study. We reviewed and analyzed the PET/CT features of gastric wall lesions, including FDG avidity, pattern (focal/diffuse), and intensity [maximal standard uptake value: (SUVmax)]. The correlation of SUVmax with gastric clinicopathological variables was investigated by χ2 test, and receiver-operating characteristic (ROC) curve analysis was performed to determine the differential diagnostic value of SUVmax-associated parameters in gastric lymphoma and gastric carcinoma.
RESULTS Fifty-two patients with gastric lymphoma and 73 with gastric carcinoma were included in this study. Abnormal gastric FDG accumulation was found in 49 patients (94.23%) with gastric lymphoma and 65 patients (89.04%) with gastric carcinoma. Gastric lymphoma patients predominantly presented with type I and type II lesions, whereas gastric carcinoma patients mainly had type III lesions. The SUVmax (13.39 ± 9.24 vs 8.35 ± 5.80, P < 0.001) and SUVmax/THKmax (maximal thickness) (7.96 ± 4.02 vs 4.88 ± 3.32, P < 0.001) were both higher in patients with gastric lymphoma compared with gastric carcinoma. ROC curve analysis suggested a better performance of SUVmax/THKmax in the evaluation of gastric lesions between gastric lymphoma and gastric carcinoma in comparison with that of SUVmax alone.
CONCLUSION PET/CT features differ between gastric lymphoma and carcinoma, which can improve PET/CT evaluation of gastric wall lesions and help differentiate gastric lymphoma from gastric carcinoma.
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Albano D, Bertoli M, Ferro P, Fallanca F, Gianolli L, Picchio M, Giubbini R, Bertagna F. 18F-FDG PET/CT in gastric MALT lymphoma: a bicentric experience. Eur J Nucl Med Mol Imaging 2016; 44:589-597. [PMID: 27619357 DOI: 10.1007/s00259-016-3518-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/05/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE The role of 18F-FDG-PET/CT in evaluating gastric MALT lymphoma is still controversial. In the literature the detection rate of 18F-FDG-PET/CT in patients with gastric MALT lymphoma is variable, and the reason for this heterogeneity is not still clear. Our aim was to investigate the particular metabolic behavior of these lymphoma. MATERIALS AND METHODS Sixty-nine patients (26 female, 43 male) with histologically confirmed gastric MALT lymphoma who underwent a 18F-FDG-PET/CT for initial staging from two centers were included. The PET images were analyzed visually and semi-quantitatively by measuring the maximum standardized uptake value (SUVmax), lesion-to-liver SUVmax ratio, and lesion-to-blood pool SUVmax ratio and compared with Ann Arbor stage, epidemiological (age, sex), histological (presence of gastritis, ulcer, H. pylori infection, plasmacytic differentiation, Ki-67 index), and morphological (tumor size, superficial lesions or mass-forming) characteristics. RESULTS Thirty-six patients (52 %) had positive PET/CT (average SUVmax was 9±6.7; lesion-to-liver SUVmax ratio 3.7±2.6, lesion-to-blood pool SUVmax ratio 4.8±3.3) at the corresponding gastric lesion; the remaining 33 were not 18F-FDG-avid. In the univariate analysis, 18F-FDG avidity was significantly associated with morphological features (mass forming p<0.001 and high maximum diameter p<0.001), Ann Arbor stage (p=0.010), and Ki67 index (p<0.001) and not correlated with age, sex, presence of gastritis, ulcer, Helicobacter pylori infection, and plasmacytic differentiation. In the multivariate analysis, the correlations with gross morphological appearance, Ann Arbor stage, and Ki-67 score were confirmed. SUVmax, lesion-to-liver SUVmax ratio, and lesion-to-blood pool SUVmax ratio correlated significantly only with Ki67 index (p=0.047; p=0.012; p=0.042). CONCLUSIONS 18F-FDG avidity was noted in 52 % of gastric MALT lymphoma and this avidity is correlated with gross morphological characteristics, tumor stage, and Ki-67 index. SUVmax, lesion-to-liver SUVmax ratio, and lesion-to-blood pool SUVmax ratio are correlated only with Ki-67 index, and only lesion-to-liver SUVmax ratio was independently associated with Ki-67 score.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, Spedali Civili Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy. .,University Milano-Bicocca, Milan, Italy.
| | - Mattia Bertoli
- Nuclear Medicine, Spedali Civili Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.,University Milano-Bicocca, Milan, Italy
| | | | - Federico Fallanca
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Gianolli
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Picchio
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
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24
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Abstract
Ménétrier disease is a very rare chronic gastric disorder characterized by gastric mucosal hypertrophy. We present a case of Ménétrier disease with CT, MRI, and FDG PET/CT findings. Enhanced CT and MRI showed diffuse thickened mucosa of the greater curvature and elongated mucosa of the antrum with remarkable enhancement. The early and delayed FDG PET/CT showed increased FDG uptake of these thickened mucosa. The increased FDG uptake may be due to the mucosal inflammation. This case indicates Ménétrier disease should be included in the differential diagnosis of abnormal gastric FDG accumulation along with tumor and nontumor processes.
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Affiliation(s)
- Aisheng Dong
- From the Departments of *Nuclear Medicine, †Gastroenterology, and ‡Hepatopanreatobiliary Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
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Hwang JW, Jee SR, Lee SH, Kim JH, Seol SY, Lee SM. Efficacy of Positron Emission Tomography/Computed Tomography in Gastric Mucosa-associated Lymphoid Tissue Lymphoma. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 67:183-8. [DOI: 10.4166/kjg.2016.67.4.183] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jin Won Hwang
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sam Ryong Jee
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Heon Lee
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji Hyun Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Yong Seol
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seok Mo Lee
- Department of Nuclear Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Lewis RB, Mehrotra AK, Rodríguez P, Manning MA, Levine MS. From the radiologic pathology archives: gastrointestinal lymphoma: radiologic and pathologic findings. Radiographics 2015; 34:1934-53. [PMID: 25384294 DOI: 10.1148/rg.347140148] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Gastrointestinal (GI) lymphoma encompasses a heterogeneous group of neoplasms that have a common lymphoid origin but variable pathologic and imaging features. Extranodal marginal zone B-cell lymphoma (ENMZL) and diffuse large B-cell lymphoma (DLBCL) are the most common. ENMZL usually occurs in the stomach, where it is associated with chronic infection by Helicobacter pylori, and is typically a superficial spreading lesion that causes mucosal nodularity or ulceration and mild wall thickening. DLBCL may arise de novo or from transformation of ENMZL or other low-grade lymphomas. This form of lymphoma produces extensive wall thickening or a bulky mass, but obstruction is uncommon. Mantle cell lymphoma is the classic cause of lymphomatous polyposis, but multiple polyps or nodules can also be seen with ENMZL and follicular lymphoma. Burkitt lymphoma is usually characterized by an ileocecal mass or wall thickening in the terminal ileum in young children, often in the setting of widespread disease. Primary GI Hodgkin lymphoma, which is rare, may be manifested by a variety of findings, though stenosis is more common than with non-Hodgkin lymphoma. Enteropathy-associated T-cell lymphoma is frequently associated with celiac disease and is characterized by wall thickening, ulceration, and even perforation of the jejunum. Accurate radiologic diagnosis of GI lymphoma requires a multifactorial approach based on the clinical findings, site of involvement, imaging findings, and associated complications.
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Affiliation(s)
- Rachel B Lewis
- From the American Institute for Radiologic Pathology, 1010 Wayne Ave, Suite 320, Silver Spring, MD 20910 (R.B.L., M.A.M.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (R.B.L.); the Joint Pathology Center, Silver Spring, Md (A.K.M.); Department of Radiology, La Princesa University Hospital, Madrid, Spain (P.R.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (M.A.M.); and Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
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Non-Hodgkin lymphoma dominated by multiple organ extranodal disease revealed on FDG PET/CT. Clin Nucl Med 2015; 40:360-3. [PMID: 25608171 DOI: 10.1097/rlu.0000000000000680] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The definition of primary extranodal lymphoma is rather controversial and often complicated by the variety of lymphoma types. Here we describe FDG PET/CT findings in 3 pediatric patients with diffuse large B-cell non-Hodgkin lymphomas dominated by extranodal lesions involving multiple organs. Lymphomas arising primarily in extranodal sites can present significant diagnostic challenges due to their morphological diversity and lack of uniformity in histopathological classification.
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Ömür Ö, Baran Y, Oral A, Ceylan Y. Fluorine-18 fluorodeoxyglucose PET-CT for extranodal staging of non-Hodgkin and Hodgkin lymphoma. Diagn Interv Radiol 2015; 20:185-92. [PMID: 24412817 DOI: 10.5152/dir.2013.13174] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE We aimed to evaluate the role of fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) involving care-dose unenhanced CT to detect extranodal involvement in patients with non-Hodgkin and Hodgkin lymphoma. MATERIALS AND METHODS Lymphoma patients (35 Hodgkin lymphoma, 75 non-Hodgkin lymphoma) who were referred for 18F-FDG PET-CT imaging, following a diagnostic contrast-enhanced CT (CE-CT) performed within the last month, were included in our study. A total of 129 PET-CT images, and all radiologic, clinical, and pathological records of these patients were retrospectively reviewed. RESULTS In total, 137 hypermetabolic extranodal infiltration sites were detected by 18F-FDG PET-CT in 62 of 110 patients. There were no positive findings by CE-CT that reflected organ involvement in 40 of 137 18F-FDG-positive sites. The κ statistics revealed fair agreement between PET-CT and CE-CT for the detection of extranodal involvement (κ=0.60). The organs showing a disagreement between the two modalities were the spleen, bone marrow, bone, and thyroid and prostate glands. In all lesions that were negative at CE-CT, there was a diffuse 18F-FDG uptake pattern in the PET-CT images. The frequency of extranodal involvement was 51% and 58% in Hodgkin and non-Hodgkin lymphoma patients, respectively. There was a high positive correlation between the maximum standardized uptake values of the highest 18F-FDG-accumulating lymph nodes and extranodal sites (r=0.67) in patients with nodal and extranodal involvement. CONCLUSION 18F-FDG PET-CT is a more effective technique than CE-CT for the evaluation of extranodal involvement in Hodgkin and non-Hodgkin lymphoma patients. PET-CT has a significant advantage for the diagnosis of diffusely infiltrating organs without mass lesions or contrast enhancement compared to CE-CT.
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Affiliation(s)
- Özgür Ömür
- From the Department of Nuclear Medicine (Ö.Ö. e-mail: , A.O, Y.C.), Ege University School of Medicine, İzmir, Turkey; the Department of Molecular Biology and Genetics (Y.B.), İzmir Institute of Technology, İzmir, Turkey
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Abstract
Although there has been a reduction of the incidence and mortality of gastric cancer, it remains among the commonest causes of cancer-related death. Accurate staging and evaluation of treatment response are vital for management. PET is used to complement anatomic imaging in cancer management. PET/computed tomography (CT) has demonstrated its potential value for preoperative staging, evaluation of response to therapy, and detection of recurrence. Not all types of gastric cancers have a high affinity for fluorodeoxyglucose. PET/CT in the evaluation and staging of gastric cancer is not established, but studies indicate that there may be an evolving role for this imaging modality.
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Affiliation(s)
- Nouf Malibari
- Nuclear Medicine, C02-8711, Royal Victoria Hospital, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada
| | - Marc Hickeson
- Nuclear Medicine, C02-8711, Royal Victoria Hospital, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
| | - Robert Lisbona
- Nuclear Medicine, C02-8711, Royal Victoria Hospital, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada
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Abstract
Primary gastrointestinal (GI) lymphomas are uncommon diseases that can involve the whole GI tract. The etiologies of the disease remain unclear, and potential risk factors include celiac disease, Helicobacter pylori infection, use of immunosuppressive agents, human immunodeficiency virus (HIV) or Epstein-Barr virus (EBV) infection and inflammatory bowel disease, etc. Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma are the most common subtypes of GI lymphomas. B-cell lymphomas of the GI tract are more common in Western countries, while in Asia-Pacific region T-cell lymphomas are more frequently reported. In this review, lymphomas in the esophagus, stomach and intestine are described, including their epidemiology, histology, clinical manifestations, endoscopic findings, radiological features and treatment.
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Affiliation(s)
- Jiang Chen Peng
- State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai Institute of Digestive Disease, Shanghai Inflammatory Bowel Disease Research Center, Shanghai, China
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31
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Tang WJ, Lv WF, Wang SC, Pan B, Xu GL. Clinical value of 18F-FDG PET/CT in diagnosis and follow-up of primary gastric lymphoma. Shijie Huaren Xiaohua Zazhi 2014; 22:5144-5148. [DOI: 10.11569/wcjd.v22.i33.5144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the clinical value of 18F-fluorodeoxygiucose positron emission computed tomography (18F-FDG PET/CT) in the diagnosis and follow-up of primary gastric lymphoma (PGL).
METHODS: Thirty-five patients with endoscopically or pathologically confirmed PGL were enrolled into this study. Among them, 12 patients underwent pre-treatment 18F-FDG PET/CT scans, and the other 23 patients (32 episodes) underwent a total of 32 post-treatment 18F-FDG PET/CT scans, with 8 scanned 2-3 times. The lesions on the images of 18F-FDG PET/CT were observed and analyzed, and the SUVmax was measured.
RESULTS: Among the 12 patients who underwent pre-treatment 18F-FDG PET/CT scans, 5 had infiltration type PGLs and showed gastric wall thickening [SUVmax = 22.5 ± 7.6 (7.2-30.9), average thickness = 3.4 cm ± 1.3 cm (1.2-4.8 cm)], 6 had nodule type [SUVmax = 24.2 ± 13.0 (5.8-39.4), average diameter = 2.8 cm ± 1.5 cm (1.0-4.6 cm), and 1 had mass type (SUVmax = 21.0, size = 19.5 cm × 1.4 cm). Among the 23 patients who underwent after-treatment 18F-FDG PET/CT scans, using endoscopic pathology or clinical follow-up beyond six months as standard, 11 had negative images, and the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of 18F-FDG PET/CT were 83.3% (10/12), 1.7% (11/12), 87.5% (21/24), 84.6% (11/13) and 84.6% (11/13), respectively.
CONCLUSION: 18F-FDG PET/CT plays an important role in the pre-treatment diagnosis of PGL as well as post-treatment surveillance of PGL from a clinical perspective.
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32
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Wu J, Zhu H, Li K, Wang XG, Gui Y, Lu GM. 18F-fluorodeoxyglucose positron emission tomography/computed tomography findings of gastric lymphoma: Comparisons with gastric cancer. Oncol Lett 2014; 8:1757-1764. [PMID: 25202405 PMCID: PMC4156241 DOI: 10.3892/ol.2014.2412] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 07/23/2014] [Indexed: 12/17/2022] Open
Abstract
The role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in numerous malignant tumors, including gastric lymphoma, is well-established. However, there have been few studies with regard to the 18F-FDG PET/CT features of gastric lymphoma. The aim of the present study was to characterize the 18F-FDG PET/CT features of gastric lymphoma, which were compared with those of gastric cancer. Prior to treatment, 18F-FDG PET/CT was performed on 24 patients with gastric lymphoma and 43 patients with gastric cancer. The 18F-FDG PET/CT pattern of gastric wall lesions was classified as one of three types: Type I, diffuse thickening of the gastric wall with increased FDG uptake infiltrating more than one-third of the total stomach; type II, segmental thickening of the gastric wall with elevated FDG uptake involving less than one-third of the total stomach; and type III, local thickening of the gastric wall with focal FDG uptake. The incidence of the involvement of more than one region of the stomach was higher in the patients with gastric lymphoma than in those with gastric cancer. Gastric FDG uptake was demonstrated in 23 of the 24 patients (95.8%) with gastric lymphoma and in 40 of the 43 patients (93.0%) with gastric cancer. Gastric lymphoma predominantly presented with type I and II lesions, whereas gastric cancer mainly presented with type II and III lesions. The maximal thickness was larger and the maximal standard uptake value (SUVmax) was higher in the patients with gastric lymphoma compared with those with gastric cancer. A positive correlation between the maximal thickness and SUVmax was confirmed for the gastric cancer lesions, but not for the gastric lymphoma lesions. There was no difference in the maximal thickness and SUVmax of the gastric wall lesions between the patients without and with extragastric involvement, for gastric lymphoma and gastric cancer. Overall, certain differences exist in the findings between gastric lymphoma and gastric cancer patients on 18F-FDG PET/CT images, which may contribute to the identification of gastric lymphoma.
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Affiliation(s)
- Jiang Wu
- Department of Nuclear Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu 210002, P.R. China
| | - Hong Zhu
- Department of Nuclear Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu 210002, P.R. China
| | - Kai Li
- Department of Pharmacology, Soochow University, Suzhou, Jiangsu 215123, P.R. China
| | - Xin-Gang Wang
- Department of Nuclear Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu 210002, P.R. China
| | - Yi Gui
- Department of Nuclear Medicine, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu 210002, P.R. China
| | - Guang-Ming Lu
- Department of Medical Imaging, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu 210002, P.R. China
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Detection rate of fluorine-18-fluorodeoxyglucose positron emission tomography in patients with marginal zone lymphoma of MALT type: a meta-analysis. Hematol Oncol 2014; 33:113-24. [DOI: 10.1002/hon.2152] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 06/09/2014] [Indexed: 01/03/2023]
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Abstract
Heterotopic pancreas is the presence of pancreatic tissue lying outside of its normal location and lacking anatomic or vascular connections with the pancreas. Heterotopic pancreas can undergo inflammatory changes similar to the normal pancreatic gland. We present 2 rare cases showing increased (18)F-FDG uptake in the heterotopic pancreatitis of the stomachs. To our knowledge, heterotopic pancreatitis with increased tracer accumulation on FDG PET/CT has not been reported before. Heterotopic pancreas should be included in the differential diagnosis of abnormal gastric FDG accumulation along with tumor and infectious processes.
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35
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Wu CX, Zhu ZH. Diagnosis and evaluation of gastric cancer by positron emission tomography. World J Gastroenterol 2014; 20:4574-4585. [PMID: 24782610 PMCID: PMC4000494 DOI: 10.3748/wjg.v20.i16.4574] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/18/2013] [Accepted: 01/15/2014] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer is the second leading cause of cancer mortality worldwide. The diagnosis of gastric cancer has been significantly improved with the broad availability of gastrointestinal endoscopy. Effective technologies for accurate staging and quantitative evaluation are still in demand to merit reasonable treatment and better prognosis for the patients presented with advanced disease. Preoperative staging using conventional imaging tools, such as computed tomography (CT) and endoscopic ultrasonography, is inadequate. Positron emission tomography (PET), using 18F-fluorodeoxyglucose (FDG) as a tracer and integrating CT for anatomic localization, holds a promise to detect unsuspected metastasis and has been extensively used in a variety of malignancies. However, the value of FDG PET/CT in diagnosis and evaluation of gastric cancer is still controversial. This article reviews the current literature in diagnosis, staging, response evaluation, and relapse monitoring of gastric cancer, and discusses the current understanding, improvement, and future prospects in this area.
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36
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Mayerhoefer ME, Karanikas G, Kletter K, Prosch H, Kiesewetter B, Skrabs C, Porpaczy E, Weber M, Pinker-Domenig K, Berzaczy D, Hoffmann M, Sillaber C, Jaeger U, Müllauer L, Simonitsch-Klupp I, Dolak W, Gaiger A, Ubl P, Lukas J, Raderer M. Evaluation of Diffusion-Weighted MRI for Pretherapeutic Assessment and Staging of Lymphoma: Results of a Prospective Study in 140 Patients. Clin Cancer Res 2014; 20:2984-93. [DOI: 10.1158/1078-0432.ccr-13-3355] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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37
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Zanni M, Moulin-Romsee G, Servois V, Validire P, Bénamor M, Plancher C, Rouic LLL, Dendale R, Vincent-Salomon A, Asselain B, Sahli R, Decaudin D. Value of18FDG PET scan in staging of ocular adnexal lymphomas: a large single-center experience. Hematology 2013; 17:76-84. [DOI: 10.1179/102453312x13221316477813] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Manuela Zanni
- Department of Clinical HematologyInstitut Curie, Paris, France
| | | | | | | | - Myriam Bénamor
- Department of Nuclear MedicineInstitut Curie, Paris, France
| | | | | | - Rémi Dendale
- Department of Radiation OncologyInstitut Curie, Paris, France
| | | | | | - Rafika Sahli
- Department of Clinical HematologyInstitut Curie, Paris, France
| | - Didier Decaudin
- Department of Clinical HematologyInstitut Curie, Paris, France
- Laboratory of Preclinical InvestigationTranslational Research Department, Institut Curie, Paris, France
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38
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Zhao K, Luo YZ, Zhou SH, Dai BL, Luo XM, Yan SX, Wang QY, Ling L. 18F-fluorodeoxyglucose positron emission tomography/computed tomography findings in mucosa-associated lymphoid tissue lymphoma of the larynx: a case report and literature review. J Int Med Res 2013; 40:1192-206. [PMID: 22906294 DOI: 10.1177/147323001204000340] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Laryngeal mucosa-associated lymphoid tissue (MALT) lymphoma is rare, with only 25 cases reported in the literature. This report presents a case of laryngeal MALT lymphoma in a 35-year-old female with a 6-year history of progressively worsening hoarseness. MALT lymphoma was diagnosed based on biopsy and immunohistochemical analysis. The patient received two cycles of cyclophosphamide + epirubicin + vincristine + prednisone (CHOP) chemo therapy, which was ineffective. (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) showed (18)F-FDG accumulation in the larynx only and identified stage IE lymphoma. CHOP chemotherapy was terminated and the patient was treated with radiotherapy. After 3 months (total radiation dose 27 Gy), (18)F-FDG PET/CT scan showed that the laryngeal lesion was in complete remission. A review of the literature on the MEDLINE(®)/PubMed(®) databases regarding laryngeal MALT lymphoma and the use of PET/CT found that radiotherapy is the first-line treatment for stage I and II MALT lymphoma.
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Affiliation(s)
- K Zhao
- PET Centre, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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39
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18F-FDG uptake in primary gastric malignant lymphoma correlates with glucose transporter 1 expression and histologic malignant potential. Int J Hematol 2012; 97:43-9. [PMID: 23212465 DOI: 10.1007/s12185-012-1225-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 11/07/2012] [Accepted: 11/13/2012] [Indexed: 02/07/2023]
Abstract
Positron emission tomography (PET) is used for staging and response evaluation in primary gastric lymphoma (PGL). However, the implications of [(18)F]-2-fluoro-2-deoxy-D-glucose ((18)F-FDG) uptake in PGL at first diagnosis have not been reported. The relationship between (18)F-FDG uptake and the expression of facilitative glucose transporters (GLUTs), hexokinase II (HK II), and Ki67, as well as malignant potential in PGL, was assessed in this study. We analyzed 23 patients with PGL [nine with diffuse large B-cell lymphoma (DLBCL); seven with high-grade mucosa-associated lymphoid tissue (MALT) lymphoma; and seven with low-grade MALT lymphoma]. The expression levels of GLUT1, GLUT3, HK II, and Ki67 were evaluated according to the percentage of positive area determined by immunohistochemistry. Standardized uptake values correlated significantly with pathological malignant potentials (low-grade/high-grade MALT lymphoma and DLBCL: p = 0.001-0.002), Ki67 (p < 0.001), and GLUT1 expression (p = 0.02). We determined that (18)F-FDG uptake is related to GLUT1 expression and tumor histological grade as well as Ki67 in PGL.
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40
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Sharma P, Suman SKC, Singh H, Sharma A, Bal C, Malhotra A, Kumar R. Primary gastric lymphoma: utility of 18F-fluorodeoxyglucose positron emission tomography-computed tomography for detecting relapse after treatment. Leuk Lymphoma 2012; 54:951-8. [PMID: 23043310 DOI: 10.3109/10428194.2012.717694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to evaluate the role of 18F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography-computed tomography (PET-CT) in detecting relapse in patients with primary gastric lymphoma (PGL) post-treatment. Data of 39 previously treated patients with PGL (age: 50.3 ± 13.8 years; male: 24) who underwent 71 (18)F-FDG PET-CT studies for suspected relapse (n = 53) or routine follow-up (n = 18) were retrospectively evaluated. PET-CT images were evaluated both qualitatively and quantitatively (standardized uptake value [SUVmax]). A combination of clinical/imaging follow-up, endoscopy and/or histopathology was taken as the reference standard. The per patient based sensitivity of PET-CT was 96%, specificity 91% and accuracy 93%. The lymph node was the commonest site of relapse on PET-CT. Mean lesion SUVmax was 5.9 ± 3.1 (2.3-13.6). Accuracy was similar in suspected relapse and routine follow-up groups (90.5% vs. 100%; p = 0.409). Based on the data, (18)F-FDG PET-CT appears to be highly accurate for the detection of relapse in patients with PGL post-treatment.
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Affiliation(s)
- Punit Sharma
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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41
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Makis W, Ciarallo A, Hickeson M, Rush C, Derbekyan V, Novales-Diaz JA, Laufer J, Stern J, Lisbona R. Spectrum of gastric malignancy on 18F-FDG PET/CT: a pictorial essay. Clin Imaging 2012; 36:432-46. [PMID: 22920343 DOI: 10.1016/j.clinimag.2011.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 12/14/2011] [Indexed: 12/12/2022]
Abstract
A wide variety of malignant gastric diseases can be detected, staged, and followed on (18)F-FDG PET/CT. Although the PET/CT findings are often nonspecific and some can be seen in certain benign gastric diseases, the aim of this atlas was to demonstrate that the wide histological spectrum of gastric tumors that can be evaluated, staged, and followed with PET/CT is much broader than current medical literature would suggest. PET/CT readers and oncologists should be aware of the utility of PET/CT in these tumors and the imaging characteristics and patterns of (18)F-FDG uptake that can be demonstrated in these cases.
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Affiliation(s)
- William Makis
- Department of Nuclear Medicine, Brandon Regional Health Centre, Brandon, Manitoba, Canada R7A 2B3.
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42
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Comparison between endoscopic macroscopic classification and F-18 FDG PET findings in gastric mucosa-associated lymphoid tissue lymphoma patients. Clin Nucl Med 2012; 37:152-7. [PMID: 22228338 DOI: 10.1097/rlu.0b013e3182393580] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim of this study was to compare endoscopic macroscopic classification with fluorine-18 fluorodeoxyglucose (F-18 FDG) uptake in gastric mucosa-associated lymphoid tissue (MALT) lymphoma and to investigate the usefulness of F-18 FDG positron emission tomography (PET) for diagnosing gastric MALT lymphoma. MATERIALS AND METHODS Sixteen patients with gastric MALT lymphoma who underwent F-18 FDG PET and gastrointestinal imaging modalities were included in this study. Sixteen healthy asymptomatic participants undergoing both F-18 FDG PET and endoscopy for cancer screening were in the control group. We investigated the difference of F-18 FDG uptake between the gastric MALT lymphoma and the control group and compared the uptake pattern in gastric MALT lymphoma with our macroscopic classification. RESULTS The endoscopic findings of 16 gastric MALT lymphoma patients were classified macroscopically as chronic gastritis-like tumors (n = 6), depressed tumors (n = 5), and protruding tumors (n = 5). Abnormal gastric F-18 FDG uptake was observed in 63% of tumors in the gastric MALT lymphoma group and 50% of cases in the control group. The median maximum standardized uptake values for gastric MALT lymphoma patients and control group were 4.0 and 2.6, respectively, the difference of which was statistically significant (P = 0.003). F-18 FDG uptake results were positive for all protruding tumors but only 50% for chronic gastritis-like tumors and 40% for depressed-type tumors. CONCLUSIONS F-18 FDG PET may be a useful method for evaluating protrusion-type gastric MALT lymphoma. When strong focal or diffuse F-18 FDG uptake is detected in the stomach, endoscopic biopsy should be performed, even if the endoscopic finding is chronic gastritis.
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43
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Abstract
Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL) represent a spectrum of malignant neoplasms arising from the lymphoid system with an incidence of around 8% of all malignancies. Although they are generally known as tumors of lymph nodes, 25% to 40% of HD/NHL tumors, especially NHL, arise at extranodal sites along the gastrointestinal tract, head and neck, orbit, central and peripheral nervous system, thorax, bone, skin, breast, testis, thyroid, and genitourinary tract. Extranodal involvement is an important pretreatment prognostic factor for patients with lymphoma and its incidence has increased in the past 2 decades. Imaging plays an important role in the noninvasive pretreatment assessment of patients with extranodal lymphoma. This involvement can be subtle and may be overlooked during computed tomography (CT). Positron emission tomography/CT (PET/CT) has evolved into an important imaging tool for evaluation of lymphomas, facilitating the detection of affected extranodal sites even when CT shows subtle or no obvious lesions. Familiarity with extranodal manifestations and suggestive PET/CT features in different sites is important for accurate evaluation of lymphoma. This article reviews the extranodal PET/CT imaging findings regarding HD and NHL.
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44
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Ichikawa K, Sugimoto K, Sato E, Sunami Y, Watanabe N, Ushimi T, Komatsu N. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography revealed the presence of simultaneous colon cancer in mucosa-associated lymphoid tissue lymphoma. Geriatr Gerontol Int 2011; 11:537-8. [PMID: 21951780 DOI: 10.1111/j.1447-0594.2011.00706.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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45
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Ghimire P, Wu GY, Zhu L. Primary gastrointestinal lymphoma. World J Gastroenterol 2011; 17:697-707. [PMID: 21390139 PMCID: PMC3042647 DOI: 10.3748/wjg.v17.i6.697] [Citation(s) in RCA: 249] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 11/11/2010] [Accepted: 11/18/2010] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal tract is the most common extranodal site involved by lymphoma with the majority being non-Hodgkin type. Although lymphoma can involve any part of the gastrointestinal tract, the most frequent sites in order of its occurrence are the stomach followed by small intestine and ileocecal region. Gastrointestinal tract lymphoma is usually secondary to the widespread nodal diseases and primary gastrointestinal tract lymphoma is relatively rare. Gastrointestinal lymphomas are usually not clinically specific and indistinguishable from other benign and malignant conditions. Diffuse large B-cell lymphoma is the most common pathological type of gastrointestinal lymphoma in essentially all sites of the gastrointestinal tract, although recently the frequency of other forms has also increased in certain regions of the world. Although some radiological features such as bulky lymph nodes and maintenance of fat plane are more suggestive of lymphoma, they are not specific, thus mandating histopathological analysis for its definitive diagnosis. There has been a tremendous leap in the diagnosis, staging and management of gastrointestinal lymphoma in the last two decades attributed to a better insight into its etiology and molecular aspect as well as the knowledge about its critical signaling pathways.
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46
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Shinagare AB, Ramaiya NH, O'Regan K, Jagannathan JP, Hornick JL, LaCasce AS. Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma. J Clin Oncol 2011; 29:e297-300. [PMID: 21245429 DOI: 10.1200/jco.2010.33.2320] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Atul B Shinagare
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
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47
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Paes FM, Kalkanis DG, Sideras PA, Serafini AN. FDG PET/CT of extranodal involvement in non-Hodgkin lymphoma and Hodgkin disease. Radiographics 2010; 30:269-91. [PMID: 20083598 DOI: 10.1148/rg.301095088] [Citation(s) in RCA: 198] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The term extranodal disease refers to lymphomatous infiltration of anatomic sites other than the lymph nodes. Almost any organ can be affected by lymphoma, with the most common extranodal sites of involvement being the stomach, spleen, Waldeyer ring, central nervous system, lung, bone, and skin. The prevalence of extranodal involvement in non-Hodgkin lymphoma and Hodgkin disease has increased in the past decade. The imaging characteristics of extranodal involvement can be subtle or absent at conventional computed tomography (CT). Imaging of tumor metabolism with 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) has facilitated the identification of affected extranodal sites, even when CT has demonstrated no lesions. More recently, hybrid PET/CT has become the standard imaging modality for initial staging, follow-up, and treatment response assessment in patients with lymphoma and has proved superior to CT in these settings. Certain PET/CT patterns are suggestive of extranodal disease and can help differentiate tumor from normal physiologic FDG activity, particularly in the mucosal tissues, bone marrow, and organs of the gastrointestinal tract. Familiarity with the different extranodal manifestations in various locations is critical for correct image interpretation. In addition, a knowledge of the differences in FDG avidity among the histologic subtypes of lymphoma, appropriate timing of scanning after therapeutic interventions, and use of techniques to prevent brown fat uptake are essential for providing the oncologist with accurate information.
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Affiliation(s)
- Fabio M Paes
- Department of Radiology, Division of Nuclear Medicine, Jackson Memorial Hospital, University of Miami and Miller School of Medicine, 1080 NW 19th Street, Miami, FL 33136, USA.
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48
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Chihara D, Oki Y, Ine S, Kato H, Onoda H, Taji H, Kagami Y, Yamamoto K, Morishima Y. Primary gastric diffuse large B-cell Lymphoma (DLBCL): analyses of prognostic factors and value of pretreatment FDG-PET scan. Eur J Haematol 2010; 84:493-8. [PMID: 20148943 DOI: 10.1111/j.1600-0609.2010.01426.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We report a single institution experience with gastric diffuse large B-cell lymphoma (DLBCL) in an attempt to evaluate the roles of different treatment modalities, to assess the value of pretreatment positron emission tomography (PET) scan, and to identify potential prognostic factors. METHODS Among 384 patients diagnosed with DLBCL between 1995 and 2008, 75 patients had primary gastric DLBCL and were reviewed and analyzed. RESULTS The median age was 66. International prognostic index (IPI) risk was low in 52%, low-intermediate in 23%, high-intermediate in 9%, and high in 16%. Pretreatment PET scan was highly sensitive in detecting gastric lesions except stage I gastric DLBCL without detectable mass by CT or gastroscopy. As a general rule, patients with limited-stage disease were treated with three times of CHOP (with or without rituximab) and radiotherapy, and those with advanced-stage disease were treated with eight cycles of CHOP (with or without rituximab), and radiotherapy was given to residual diseases after chemotherapy. Three-year overall survival (OS) rate was 78%. Multivariate analysis revealed that low albumin, hemoglobin <12.0 g/dL, and treatment without rituximab were independently associated with shorter OS. Low albumin, hemoglobin <12.0 g/dL,and advanced stage were independently associated with shorter progression-free survival. CONCLUSION We showed the survival benefit of rituximab and potential prognostic value of pretreatment hemoglobin and serum albumin levels in gastric DLBCL.
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Affiliation(s)
- Dai Chihara
- Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan
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49
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Weiler-Sagie M, Bushelev O, Epelbaum R, Dann EJ, Haim N, Avivi I, Ben-Barak A, Ben-Arie Y, Bar-Shalom R, Israel O. (18)F-FDG avidity in lymphoma readdressed: a study of 766 patients. J Nucl Med 2009; 51:25-30. [PMID: 20009002 DOI: 10.2967/jnumed.109.067892] [Citation(s) in RCA: 267] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
UNLABELLED PET/CT with (18)F-FDG is an important noninvasive diagnostic tool for management of patients with lymphoma, and its use may surpass current guideline recommendations. The aim of the present study is to enlarge the growing body of evidence concerning (18)F-FDG avidity of lymphoma to provide a basis for future guidelines. METHODS The reports from (18)F-FDG PET/CT studies performed in a single center for staging of 1,093 patients with newly diagnosed Hodgkin disease and non-Hodgkin lymphoma between 2001 and 2008 were reviewed for the presence of (18)F-FDG avidity. Of these patients, 766 patients with a histopathologic diagnosis verified according to the World Health Organization classification were included in the final analysis. (18)F-FDG avidity was defined as the presence of at least 1 focus of (18)F-FDG uptake reported as a disease site. Nonavidity was defined as disease proven by clinical examination, conventional imaging modalities, and histopathology with no (18)F-FDG uptake in any of the involved sites. RESULTS At least one (18)F-FDG-avid lymphoma site was reported for 718 patient studies (94%). Forty-eight patients (6%) had lymphoma not avid for (18)F-FDG. (18)F-FDG avidity was found in all patients (100%) with Hodgkin disease (n = 233), Burkitt lymphoma (n = 18), mantle cell lymphoma (n = 14), nodal marginal zone lymphoma (n = 8), and lymphoblastic lymphoma (n = 6). An (18)F-FDG avidity of 97% was found in patients with diffuse large B-cell lymphoma (216/222), 95% for follicular lymphoma (133/140), 85% for T-cell lymphoma (34/40), 83% for small lymphocytic lymphoma (24/29), and 55% for extranodal marginal zone lymphoma (29/53). CONCLUSION The present study indicated that with the exception of extranodal marginal zone lymphoma and small lymphocytic lymphoma, most lymphoma subtypes have high (18)F-FDG avidity. The cumulating evidence consistently showing high (18)F-FDG avidity in the potentially curable Burkitt, natural killer/T-cell, and anaplastic large T-cell lymphoma subtypes justifies further investigations of the utility of (18)F-FDG PET in these diseases at presentation.
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F-18 FDG PET/CT Findings in a Patient With Bilateral Orbital and Gastric Mucosa-Associated Lymphoid Tissue Lymphomas. Clin Nucl Med 2009; 34:589-93. [DOI: 10.1097/rlu.0b013e3181b06c03] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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