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Year : 2010  |  Volume : 25  |  Issue : 4  |  Page : 178  

Increased renal corticomedullary FDG activity in a patient of NHL-malignant or benign?


Yashoda Hospital, Hyderabad, India

Date of Web Publication23-Mar-2011

Correspondence Address:
Tushar Mohapatra
Nuclear Medicine and PET/CT Consultant, Yashoda Cancer Institute, Raj Bhavan Road, Somajiguda, Hyderabad - 500 082
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.78260

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   Abstract 

Authors describe diagnostic dilemma of differentiating pyelonephritis with lymphomatous involvement of kidney in a known case of lymphoma. FDG uptake pattern was non-discriminatory and pyelonephritis diagnosed retrospectively on follow up study. Authors emphasize the importance of recognition of features and subtle clues of infection evident on CT component of PET-CT.

Keywords: FDG PET-CT, pyelonephritis, lymphoma


How to cite this article:
Arora AJ, Mohapatra T, Shaikh S, Arora RA. Increased renal corticomedullary FDG activity in a patient of NHL-malignant or benign?. Indian J Nucl Med 2010;25:178

How to cite this URL:
Arora AJ, Mohapatra T, Shaikh S, Arora RA. Increased renal corticomedullary FDG activity in a patient of NHL-malignant or benign?. Indian J Nucl Med [serial online] 2010 [cited 2019 Nov 15];25:178. Available from: http://www.ijnm.in/text.asp?2010/25/4/178/78260

Kidneys being the physiological route of excretion of F18-FDG pose significant problem while interpreting its involvement by focal or diffuse hypermetabolic lesions like malignancies and inflammatory processes. Physiological pelvicalyceal activity can be dealt with the help of intravenous diuretics, oral hydration, and delayed imaging. It is known that lesions of lymphoma with renal involvement are FDG avid and early identification of this pathology causing ARF is crucial for recovery of kidney function. [1],[2] To differentiate the lymphomatous involvement of kidney from other inflammatory pathologies, due consideration is to be given to other CT features like renal calculi, perirenal fat stranding, and thickened perirenal fascia [[Figure 1]a-b]. [3]
Figure 1: Review of pre- and post-therapy PET CT studies of a 71-year-old male patient, a known case of abdominal non-Hodgkin's lymphoma, revealed significant reduction in size and metabolic activity of retroperitoneal lymphomatous lesion. Increased FDG activity in the corticomedullary space of right kidney in pretherapy study (a), reported as lymphomatous involvement, was not seen in the subsequent scan which showed decreased size. Serum creatinine levels showed increase in values from 0.8 to 2.3 during the interval between these studies, for which a non-contrast follow-up PET/CT study was done.- In follow-up PET/CT study, previously normal appearing left kidney showed intense corticomedullary tracer activity along with associated surrounding fat stranding and thickened perirenal fascia bilaterally (b). Above findings suggested inflammatory/pyelonephritic nature of the disease, thus impressing upon the importance of early detection of inflammatory etiology of the kidney and differentiating it from malignant involvement while reporting PET/CT cases showing increased corticomedullary renal uptake.

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   References Top

1.Reuter S, Rahbar K, Busch V, Hillebrand U, Velden J, Pavenstädt H, et al. Acute renal failure due to primary bilateral renal large B-cell lymphoma: Diagnostics and follow-up by FDG-PET/CT. Clin Nucl Med 2009;34:722-4.  Back to cited text no. 1
    
2.Ye XH, Chen LH, Wu HB, Feng J, Zhou WL, Yang RM, et al. 18F-FDG PET/CT evaluation of lymphoma with renal involvement: Comparison with renal carcinoma. South Med J 2010;103:642-9.  Back to cited text no. 2
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3.Kawashima A, Sandler CM, Goldman SM, Raval BK, Fishman EK. CT of Renal Inflammatory Disease. Radiographics 1997;17:851-66.  Back to cited text no. 3
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