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Direct Comparison of FDG PET and CT Findings in Patients with Lymphoma: Initial Experience

Published Online:Dec 1 2005https://doi.org/10.1148/radiol.2373040555

Abstract

PURPOSE: To retrospectively compare fluorine 18 fluorodeoxyglucose (FDG) positron emission tomographic (PET) and computed tomographic (CT) findings at the same anatomic locations in patients with lymphoma by using a combined PET/CT scanner and to analyze the lesions on metabolic and anatomic bases to evaluate causes of discrepant findings between the two modalities.

MATERIALS AND METHODS: The institutional review board allowed an exempt retrospective review of cancer PET database, and informed consent was waived. The study was HIPAA compliant. Fifty-three patients with lymphoma (20 Hodgkin and 33 non-Hodgkin; mean age, 43 years; range, 12–83 years) who underwent FDG PET/CT were included. The PET and CT images were interpreted by two nuclear medicine physicians and one radiologist, respectively, blinded to the other imaging findings. Concordant PET and CT findings were regarded as positive or negative for lymphoma. The site with discordant findings was defined as positive for disease if it was accompanied by other PET- and CT-positive sites in the same patient or was confirmed clinically (histologic examination or progressive disease). Staging results were also compared by one nuclear medicine physician.

RESULTS: Of a total of 1537 anatomic sites in 53 patients, 48 had discordant findings between PET and CT. Forty (83%) of the 48 sites had correct PET findings (31 positive, nine negative), five had correct CT findings, and three were unresolved. The 31 PET-positive and CT-negative sites accounted for 23% of all 134 true-positive PET sites. PET provided accurate staging in an incremental nine (17%, upstaging in four and downstaging in five) of 53 patients in whom CT staging was incorrect. CT provided correct upstaging in two patients.

CONCLUSION: FDG PET/CT as a combined modality may contribute substantially to lesion characterization and staging in patients with lymphoma.

© RSNA, 2005

References

  • 1 Radford JA, Cowan RA, Flanagan M, et al. The significance of residual mediastinal abnormality on the chest radiograph following treatment for Hodgkin's disease. J Clin Oncol 1988; 6: 940–946.
    Medline Google Scholar
  • 2 Surbone A, Longo DL, De Vita VT, et al. Residual abdominal masses in aggressive non-Hodgkin's lymphoma after combination chemotherapy: significance and management. J Clin Oncol 1988;6:1832–1837.
    Medline Google Scholar
  • 3 Jerusalem G, Beguin Y, Fassotte MF, et al. Whole-body positron emission tomography using 18F-fluorodeoxyglucose for posttreatment evaluation in Hodgkin's disease and non-Hodgkin's lymphoma has higher diagnostic and prognostic value than classical computed tomography scan imaging. Blood 1999;94:429–433.
    Medline Google Scholar
  • 4 Delbeke D. Oncological applications of FDG PET imaging: brain tumors, colorectal cancer, lymphoma and melanoma. J Nucl Med 1999;40:591–603.
    Medline Google Scholar
  • 5 Rohren EM, Turkington TG, Coleman RE. Clinical applications of PET in oncology. Radiology 2004;231:305–332.
    Google Scholar
  • 6 Delbeke D. Oncological applications of FDG PET imaging. J Nucl Med 1999;40:1706–1715.
    Medline Google Scholar
  • 7 Gambhir SS, Czernin J, Schwimmer J, et al. A tabulated summary of the FDG PET literature. J Nucl Med 2001; 42(suppl 1):1S–93S.
    Medline Google Scholar
  • 8 Rehm PK. Radionuclide evaluation of patients with lymphoma. Radiol Clin North Am 2001;39:957–978.
    Medline Google Scholar
  • 9 Kostakoglu L, Leonard JP, Kuji I, et al. Comparison of fluorine-18 fluorodeoxyglucose positron emission tomography and Ga-67 scintigraphy in evaluation of lymphoma. Cancer 2002;94:879–888.
    Medline Google Scholar
  • 10 Beyer T, Townsend DW, Brun T, et al. A combined PET/CT scanner for clinical oncology. J Nucl Med 2000;41:1369–1379.
    Medline Google Scholar
  • 11 Ell PJ, Von Schulthess GK. PET/CT: a new road map [editorial]. Eur J Nucl Med Mol Imaging 2002;29:719–720.
    Medline Google Scholar
  • 12 Antoch G, Freudenberg LS, Stattaus J, et al. Whole-body positron emission tomography-CT: optimized CT using oral and IV contrast materials. AJR Am J Roentgenol 2002;179:1555–1560.
    Medline Google Scholar
  • 13 Moog F, Bangerter M, Diederichs CG, et al. Lymphoma: role of whole-body 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) PET in nodal staging. Radiology 1997;203:795–800.
    Google Scholar
  • 14 National Cancer Institute. Adult Hodgkin's lymphoma: treatment. http://www.cancer.gov/cancertopics/pdq/treatment/adulthodgkins/HealthProfessional/page3. Accessed November 10, 2004.
    Google Scholar
  • 15 National Cancer Institute. Adult non-Hodgkin's lymphoma: treatment. http://www.nci.nih.gov/cancertopics/pdq/treatment/adult-non-hodgkins/HealthProfessional/page3. Accessed November 10, 2004.
    Google Scholar
  • 16 Newman JS, Francis IR, Kaminski MS, et al. Imaging of lymphoma with PET with 2-[F-18]-fluoro-2-deoxy-D-glucose: correlation with CT. Radiology 1994;190:111–116.
    Google Scholar
  • 17 Buchmann I, Reinhardt M, Elsner K, et al. 2-(fluorine-18)fluoro-2-deoxy-D-glucose positron emission tomography in the detection and staging of malignant lymphoma: a bicenter trial. Cancer 2001;91:889–899.
    Medline Google Scholar
  • 18 Moog F, Bangerter M, Diederichs CG, et al. Extranodal malignant lymphoma: detection with FDG PET versus CT. Radiology 1998;206:475–481.
    Google Scholar
  • 19 Dittmann H, Sokler M, Kollmannsberger C, et al. Comparison of 18FDG-PET with CT scans in the evaluation of patients with residual and recurrent Hodgkin's lymphoma. Oncol Rep 2001;8:1393–1399.
    Medline Google Scholar
  • 20 Gupta NC, Graeber GM, Bishop HA. Comparative efficacy of positron emission tomography with fluorodeoxyglucose in evaluation of small (<1 cm), intermediate (1 to 3 cm), and large (>3 cm) lymph node lesions. Chest 2000;117:773–778.
    Medline Google Scholar
  • 21 Romer W, Hanauske AR, Ziegler S, et al. Positron emission tomography in non-Hodgkin's lymphoma: assessment of chemotherapy with fluorodeoxyglucose. Blood 1998;91:4464–4471.
    Medline Google Scholar
  • 22 Weihrauch MR, Re D, Scheidhauer K, et al. Thoracic positron emission tomography using 18F-fluorodeoxyglucose for the evaluation of residual mediastinal Hodgkin disease. Blood 2001;98:2930–2934.
    Medline Google Scholar
  • 23 Wahl RL, Zasadny K, Helvie M, et al. Metabolic monitoring of breast cancer chemohormonotherapy using positron emission tomography: initial evaluation. J Clin Oncol 1993;11:2101–2111.
    Medline Google Scholar
  • 24 Hany TF, Gharehpapagh E, Kamel EM, et al. Brown adipose tissue: a factor to consider in symmetrical tracer uptake in the neck and upper chest region. Eur J Nucl Med Mol Imaging 2002;29:1393–1398.
    Medline Google Scholar
  • 25 Cohade C, Mourtzikos KA, Wahl RL. "USA-Fat": prevalence is related to ambient temperature-evaluation with 18F-FDG PET/CT. J Nucl Med 2003;44(8):1267–1270.
    Google Scholar
  • 26 Bar-Shalom R, Yefremov N, Guralnik L, et al. Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. J Nucl Med 2003;44:1200–1209.
    Medline Google Scholar
  • 27 Cohade C, Osman M, Leal J, Wahl RL. Direct comparison of (18)F-FDG PET and PET/CT in patients with colorectal carcinoma. J Nucl Med 2003;44:1797–1803.
    Medline Google Scholar

Article History

Published in print: 2005