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  Indian J Med Microbiol
 

Figure 15: Maximum intensity projection (MIP) image (a) of staging positron emission tomography/computed tomography (PET/CT) of a patient with diffuse large B cell lymphoma (DLBCL) shows abdominal lymph nodal mass and few other lymph nodes in thorax. However there is no splenic involvement. Interim PET/CT (b) done after two cycles after chemotherapy shows intense fluoro-deoxy-glucose (FDG) uptake in entire marrow and spleen along with residual disease in left adrenal gland. PET/CT was done after 2 days after granulocyte colony-stimulating factor (G-CSF) administration and the uptake is noted diffusely in spleen and bone marrow suggestive of reactive bone marrow uptake post G-CSF administration, moreover there was no splenic involvement in staging PET/CT. MIP image, (c) of staging PET/CT of another patient with DLBCL showing heterogeneous FDG uptake in spleen suggesting involvement along with abdominal and thoracic lymph nodal disease. MIP image, (d) of PET/CT scan done after two cycles of chemotherapy show a focal FDG uptake in spleen. Though G-CSF was administered in this patient too, it was administered 11 days prior to interim PET/CT and also the residual uptake was focal and related to previously involved site suggesting true positive residual disease in spleen. This image highlights the false positive uptake in spleen and bone marrow following G-CSF administration in patients with lymphoma. Correlation with duration since G-CSF administration, knowledge about previous involved sites and pattern of uptake aids in accurate differentiation of false positive uptake from disease involvement

Figure 15: Maximum intensity projection (MIP) image (a) of staging positron emission tomography/computed tomography (PET/CT) of a patient with diffuse large B cell lymphoma (DLBCL) shows abdominal lymph nodal mass and few other lymph nodes in thorax. However there is no splenic involvement. Interim PET/CT (b) done after two cycles after chemotherapy shows intense fluoro-deoxy-glucose (FDG) uptake in entire marrow and spleen along with residual disease in left adrenal gland. PET/CT was done after 2 days after granulocyte colony-stimulating factor (G-CSF) administration and the uptake is noted diffusely in spleen and bone marrow suggestive of reactive bone marrow uptake post G-CSF administration, moreover there was no splenic involvement in staging PET/CT. MIP image, (c) of staging PET/CT of another patient with DLBCL showing heterogeneous FDG uptake in spleen suggesting involvement along with abdominal and thoracic lymph nodal disease. MIP image, (d) of PET/CT scan done after two cycles of chemotherapy show a focal FDG uptake in spleen. Though G-CSF was administered in this patient too, it was administered 11 days prior to interim PET/CT and also the residual uptake was focal and related to previously involved site suggesting true positive residual disease in spleen. This image highlights the false positive uptake in spleen and bone marrow following G-CSF administration in patients with lymphoma. Correlation with duration since G-CSF administration, knowledge about previous involved sites and pattern of uptake aids in accurate differentiation of false positive uptake from disease involvement