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INTERESTING IMAGE
Year : 2017  |  Volume : 32  |  Issue : 1  |  Page : 77-78  

18F-FDG pet/ct/mri fusion images showing cranial and peripheral nerve involvement in neurolymphomatosis


1 Nuclear Medicine and Molecular Imaging Section, Ribeirão Preto Medical School, University of São Paulo, São Paulo; Bioengineering Interunits Postgraduation Program, São Carlos School of Engineering, University of São Paulo, São Carlos, Brazil
2 Division of Hematology of the Internal Medicine Department and Postgraduation Program. Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
3 Nuclear Medicine and Molecular Imaging Section, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil

Date of Web Publication17-Jan-2017

Correspondence Address:
Ana Carolina Trevisan
Seção de Medicina Nuclear do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto – SP, Brasil. Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto - SP
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.198502

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   Abstract 

We report a 56-year-old female patient with non-Hodgkin's diffuse large B cell lymphoma (NHL) who, on magnetic resonance imaging (MRI) with a T1 weighted and gadolinium-enhanced imaging, was found to have thickening and infiltration in 75% of peripheral nerves of the patient and enlargements of cranial nerves, possibly related to lymphomatous infiltration. Subsequent positron emission tomography/computed tomography (PET/CT) using 18F-labeled 2-deoxy-2-fluoro-d-glucose (18F-FDG) showed widespread active involvement of the cervical plexus, bilateral peripheral nerves, right femoral nerve, the parasellar region of the skull, and marked hypermetabolism in the left trigeminal ganglia. This case re-emphasizes that while CT and MRI provide anatomical details, 18F-FDG PET/CT images better delineate the metabolic activity of neurolymphomatosis (NL) in the peripheral and central nervous system.

Keywords: 18 F-FDG, neurolymphomatosis, non-Hodgkin lymphoma, PET/CT


How to cite this article:
Trevisan AC, Ribeiro FB, Itikawa EN, Alexandre LS, Pitella FA, Santos AC, Simões BP, Wichert-Ana L. 18F-FDG pet/ct/mri fusion images showing cranial and peripheral nerve involvement in neurolymphomatosis. Indian J Nucl Med 2017;32:77-8

How to cite this URL:
Trevisan AC, Ribeiro FB, Itikawa EN, Alexandre LS, Pitella FA, Santos AC, Simões BP, Wichert-Ana L. 18F-FDG pet/ct/mri fusion images showing cranial and peripheral nerve involvement in neurolymphomatosis. Indian J Nucl Med [serial online] 2017 [cited 2019 Dec 15];32:77-8. Available from: http://www.ijnm.in/text.asp?2017/32/1/77/198502

A 56-Year-Old Female Patient With Non-Hodgkin's Diffuse Large B-Cell Lymphoma (Nhl) Presenting With Hoarseness, Nasal Obstruction, Left Facial Paralysis, and Numbness Was Confirmed to Have Aseptic Meningitis on Lumbar Puncture Examination. Treatment Started for Meningitis and Chemotherapy for Lymphoma. the Patient Continued to Show Clinical and Neurological Deterioration With Confused State and a Decreased Level of Consciousness. Gadolinium-Enhanced T1 Weighted Magnetic Resonance Imaging (Mri) Image Showed Thickening and Infiltration in 75% of Peripheral Nerves of the Patient and Enlargements of Cranial Nerves, Possibly Related to Lymphomatous Infiltration. Subsequently Patient Was Subjected to 18f-Labeled 2-Deoxy-2-Fluoro-d-Glucose (18f-Fdg) Positron Emission Tomography/computed Tomography (Pet/ct) [Figure 1].
Figure 1: 18F-FDG PET/CT/MRI fusion showed thickening and infiltration in 75% of peripheral nerves and enlargements of cranial nerves in the parasellar region of the skull with marked hypermetabolism in the left trigeminal ganglia (A), possibly related to lymphomatous infiltration. 18F-FDG PET/CT showing widespread active involvement of the cervical plexus, bilateral peripheral nerves, and Right femoral nerve (B) with a conspicuous lymphomatous infiltration through the lateral foramina in the lumbar spine (C). (R, Right; L, left; A, anterior; P, posterior)

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Neurolymphomatosis (NL) is a rare disorder characterized by infiltration of nerves, aggressive subtypes of NHL or leukemia.[1],[2] It is related to peripheral nervous system infiltration by lymphomatous lymphocytes cells of cranial nerves, trunk nerves, nerve roots, and plexus in the setting of a hematologic malignancy.[3] Most commonly, NL presents as a painful polyneuropathy or polyradiculopathy, followed by cranial neuropathy, painless polyneuropathy, and peripheral mononeuropathy.[4] Diagnosis requires a high index of clinical suspicion and histopathologic confirmation of an involved nerve by biopsy, or at autopsy. Brain and spinal nerves MRI, and CT of the trunk are essential in providing an overview of the structural involvement, but in some cases, just anatomic images can be ineffective in showing the active malignancy.[5] In this setting, PET/CT is being highly recommended to evaluate the extent of disease throughout the body complementing the anatomical images.[6],[7],[8] This case evidences that 18F-FDG PET/CT images better delineated the metabolic activity of NL in the peripheral and central nervous system.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Gan HK, Azad A, Cher L. Neurolymphomatosis: Diagnosis, management, and outcomes in patients treated with rituximab. Neuro Oncol 2010;12:212-15.  Back to cited text no. 1
    
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WEN-LAN Z. Usefulness of 18F-FDG PET/CT in the detection of neurolymphomatosis. Nuclear Med Comm 2014;35:1107-11.  Back to cited text no. 2
    
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Levitt LJ, Dawson DM, Rosenthal DS. CNS involvement in the non-Hodgkin's lymphomas. Cancer 1980;45:545-52.  Back to cited text no. 3
    
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Baehring JM, Batchelor TT. Diagnosis and management of neurolymphomatosis. Cancer J 2012;18:463-68.  Back to cited text no. 4
    
5.
Shimizu I, Hamano Y, Sato S. Neurolymphomatosis in a patient with extranodal NK/T-cell lymphoma, nasal-type: A case report and literature review. Intern Med 2014;53:471-75.  Back to cited text no. 5
    
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Baehring JM, Damek D, Martin EC. Neurolymphomatosis. Neuro Oncol 2003;5:104-15.  Back to cited text no. 6
    
7.
Grisariu S, Avni B, Batchelor TT. Neurolymphomatosis: An International Primary CNS Lymphoma Collaborative Group report. Blood 2010;115:5005-11.  Back to cited text no. 7
    
8.
Peterson J, Caliskan B, Bonyadlou S. Positron emission tomography/computerized tomography imagng of multiple focus of neurolymphomatosis. Indian J Nucl Med 2014;29:52-53.  Back to cited text no. 8
    


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