Indian Journal of Nuclear Medicine

PICTORIAL ESSAY
Year
: 2013  |  Volume : 28  |  Issue : 2  |  Page : 85--92

Fluoro-deoxy-glucose positron emission tomography/computed tomography in lymphoma: A pictorial essay


Kuruva Manohar1, Bhagwant Rai Mittal1, Anish Bhattacharya1, Pankaj Malhotra2, Subhash Varma2,  
1 Department of Nuclear Medicine & PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Bhagwant Rai Mittal
Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India

Abstract

F-18 fluoro-deoxy-glucose (FDG) positron emission tomography/computed tomography (PET/CT) has emerged as a powerful imaging modality in the field of oncology. F-18 FDG PET/CT is now an established tool in the management of lymphoma. This has been shown to be useful in staging, detection of bone marrow involvement (BMI), early response assessment and end of therapy response assessment in lymphoma. Interpretation of F-18 FDG PET/CT in lymphoma is carried out by various qualitative response assessment criteria. London criteria are used for interpretation of interim PET/CT and International Harmonization Project (IHP) criteria are used to interpret PET/CT done after the end of chemotherapy. Quantitative analysis is also found to be useful in assessment of response early after two cycles of chemotherapy in patients with diffuse large B cell lymphoma (DLBCL). This pictorial essay provides few images describing the FDG avidity of lymphoma, patterns of bone marrow uptake and their relevance in predicting BMI, role of staging PET/CT, quantitative analysis in response assessment, example images of response according to London criteria and IHP criteria. Few pitfalls in imaging of lymphoma with PET/CT are also discussed in the images legend.



How to cite this article:
Manohar K, Mittal BR, Bhattacharya A, Malhotra P, Varma S. Fluoro-deoxy-glucose positron emission tomography/computed tomography in lymphoma: A pictorial essay.Indian J Nucl Med 2013;28:85-92


How to cite this URL:
Manohar K, Mittal BR, Bhattacharya A, Malhotra P, Varma S. Fluoro-deoxy-glucose positron emission tomography/computed tomography in lymphoma: A pictorial essay. Indian J Nucl Med [serial online] 2013 [cited 2020 Aug 10 ];28:85-92
Available from: http://www.ijnm.in/text.asp?2013/28/2/85/118256


Full Text

 Introduction



F-18 fluoro-deoxy-glucose (FDG) positron emission tomography/computed tomography (PET/CT) is now an established tool in the management of patients with lymphoma, especially for staging, detection of bone marrow involvement (BMI), early response assessment and end of therapy response assessment. We, in this pictorial depict few images highlighting the role of FDG PET in the management of lymphoma with respect to patterns of FDG avidity and response evaluation according to different criteria. Few pitfalls in imaging of lymphoma with PET/CT also have been discussed.

 Materials and Methods



The positron emission tomography/computed tomography (PET/CT) scans were acquired 60 min after intravenous injection of 370-444 MBq of fluoro-deoxy-glucose (FDG) via an already secured peripheral venous catheter. Images from the base of the skull to the mid-thigh were acquired in three dimensional modes at 2 min per bed position in the supine position with their arms raised over the head, using a PET/CT scanner (Discovery STE 16, GE Healthcare, Milwaukee, USA) having16 slice light speed CT component. It was ensured that all the patients had fasted for at least 6 h before the radiotracer injection. Fasting blood glucose level of less than 150 mg/dl was a standard requirement for imaging in all patients. Non contrast-enhanced CT images (120 kVp) were acquired in helical mode with slice thickness of 5 mm. The acquired data was reconstructed using standard ordered subset expectation maximization algorithm. The CT, PET and co-registered PET/CT images were reviewed in transaxial, coronal and sagittal planes along with maximum-intensity projection whole-body coronal images. All images [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15] were reviewed jointly by two nuclear medicine physicians. These images highlight the role of PET/CT in staging, interim response, response evaluation and interpretation criteria. Various indications of FDG PET/CT are depicted in [Table 1].{Figure 1}{Figure 2}{Figure 3}{Figure 4}{Figure 5}{Figure 6}{Figure 7}{Figure 8}{Figure 9}{Figure 10}{Figure 11}{Figure 12}{Figure 13}{Figure 14}{Figure 15}{Table 1}[14]

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