18F-FDG PET/CT in primary central nervous system lymphoma in HIV-negative patients

OBJECTIVE: To determine the value of F-FDG PET/CT in the different manifestations of primary central nervous system lymphoma (PCNSL) in HIV-negative patients. METHODS: All PCNSL and HIV-negative patients referred for PET/CT in our institution from July 2001 to June 2006 were retrospectively studied. PET/CT examinations were reviewed by two experienced readers and evaluated for each possible anatomical site of nervous system involvement: cerebral, spinal/nerve and ocular. PET/CT results were characterized as true positive or negative and false positive or negative according to the status of the disease, which was determined after the evaluation of biopsies, laboratory, clinical and imaging examinations, and follow-up. RESULTS: Forty-two PET/CT examinations were carried out in 25 PCNSL patients. For intracerebral disease, PET/CT was true positive in 13 cases, true negative in 27 and false negative in two. For disease involving spinal cord and/or nerves, PET/CT was true positive in four cases, true negative in 37 and false negative in one. For ocular disease, PET was true positive in only one case and false negative in four. The sensitivity of PET/CT in detecting active disease in the brain was 87% (13/15), in the spine/nerves 80% (4/5), and in the eyes only 20% (1/5). CONCLUSION: PET/CT seems to be sensitive for the detection of viable intracerebral as well as for spinal and peripheral nerve disease, but not for the detection of ocular involvement.     

18F-FDG PET/CT in HIV-related central nervous system pathology

Purpose

To evaluate the utility of ¹⁸F-FDG PET/CT in suspected cerebral pathology in HIV-infected individuals.

Methods

¹⁸F-FDG PET/CT scans from 29 HIV-infected individuals (29 brain scans, 22 whole-body scans) who presented with neurological symptoms and signs were retrospectively reviewed and compared with subsequent clinical investigations.

Results

The majority of patients (n?=?25) were referred to differentiate infection from malignant causes of cerebral pathology. Ten of the 11 patients with an eventual diagnosis of toxoplasmosis infection were correctly diagnosed by ¹⁸F-FDG PET/CT showing lesional uptake less than that of normal brain cortex (mean SUVmax 3.5, range 1.9 – 5.8). All five patients with a final diagnosis of primary central nervous system lymphoma (PCNSL) were correctly diagnosed by ¹⁸F-FDG PET/CT showing lesional uptake greater than that of normal brain cortex (mean SUVmax 18.8, range 12.4 – 29.9). Four of the five patients with ¹⁸F-FDG PET/CT features suggesting a vasculitic process had vasculitis confirmed as the final diagnosis. Three patients showed variable uptake in multiple cerebral lesions (including final diagnoses of tuberculosis and metastases from lung cancer in two patients) and there were four other miscellaneous diagnoses. In 12 patients biopsies were performed at sites guided by PET abnormality (7 brain, 5 lymph nodes) confirming or excluding significant disease in 11.

Conclusion

¹⁸F-FDG PET/CT is particularly useful for differentiating between infection and PCNSL in HIV-infected patients with a cerebral lesion on MRI or CT. ¹⁸F-FDG PET/CT was also a helpful tool in the diagnostic work-up of patients with other HIV-related cerebral pathology. Additional advantages of ¹⁸F-FDG PET/CT are the abilities to assess abnormally increased glucose metabolism in the body and to identify potential sites for biopsy.     

^18F-FDG PET在原发性肾上腺淋巴瘤中的作用

目的探讨^18F—FDGPET（PET／CT）在原发性肾上腺淋巴瘤（PAL）中的作用。方法回顾性分析2005年10月至2009年8月确诊为PAL的3例患者。3例均为老年男性,双侧性NHL,治疗前均行超声、CT及PET（PET／CT）检查,并有组织病理学诊断资料。采用利妥昔单抗（rituximab）与环磷酰胺（cyclophosphamide）、表阿霉素（doxorubicin）、长春新碱（vincristine）、泼尼松（prednisone）组合（R—CHOP）方案化疗。治疗后1例进行了PET／CT的随访复查。^18F—FDGPET显像获得病灶SUVmax及与肝SUVmax的比值。结果3例均为双侧性弥漫大B细胞型PAL,骨髓穿刺阴性,R-CHOP方案化疗后,例1通过4次^18F—FDGPET复查随访、指导治疗,已存活1年7个月;例2伴有肾上腺皮质功能低下,6个月后死亡;例3年龄大（77岁）,病情重,手术部分切除后化疗,12个月后死亡。结论PAL虽然恶性程度极高,但如能早期诊断,并进行^18F—FDGPET疗效监测、修正治疗方案,可延长患者生存期。     

^13N—NH3·H2O联合^18F-FDG显像鉴别诊断原发性中枢神经系统淋巴瘤和胶质瘤

目的探讨^13N-NH3·H2O联合^18F—FDGPET／CT显像在鉴别原发性中枢神经系统淋巴瘤（PCNSL）和胶质瘤中的价值。方法对2010年1月至2012年7月就诊的10例PCNSL患者[男7例,女3例,年龄43—74（59．10±12．47）岁]和15例胶质瘤患者[男8例,女7例,年龄14～72（46．73±19．61）岁]进行^13N-NH3·H2O和^18F—FDGPET／CT显像。以肿瘤与脑灰质摄取比（T／G）评价肿瘤的放射性摄取量。采用两样本t检验比较不同肿瘤对显像剂的摄取差异,通过判别函数分析两者联合的诊断效果。结果PCNSL组^18F—FDG的T／G值明显高于胶质瘤组,分别为3．27±1．21和1．57±0．39（t=5．630,P〈0．001）,而PCNSL组^13N—NH3·H2O的T／G值明显低于胶质瘤组,分别为1．43±0．26和2．12±0．69（t=-3．551,P〈0．01）。相对于^13N—NH3·H2O的T／G值,所有PCNSL病灶（14个）均表现为高的^18F-FDGT／G值,而77．8％（14／18）的胶质瘤病灶则显示相反的结果。利用判别函数分析,2种显像剂联合对肿瘤分类的整体准确性达96．9％（31／32）,仅1例胶质瘤病灶误判为PCNSL。结论^13N-NH3·H2O联合^18F-FDG有助于鉴别PCNSL和胶质瘤。     

Prognostic role of pretreatment 18F-FDG PET/CT in primary brain lymphoma

Objective

Primary brain lymphoma is an aggressive extranodal non-Hodgkin lymphoma with poor prognosis. Many possible prognostic factors are investigated with controversial results, but possible prognostic role of 18fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) features remains unclear. Our aim was to study the metabolic behavior of brain lymphoma at 18F-FDG PET/CT and the prognostic impact of qualitative and semiquantitative PET/CT parameters.

Methods

Between 2006 and 2018, 52 patients (26 females and 26 males; mean age: 61 years) with histologically confirmed diagnosis of brain lymphoma who underwent 18F-FDG PET/CT for staging before any treatment were included. PET images were qualitatively and semiquantitatively analyzed by measuring the maximum standardized uptake value body weight (SUVbw), lean body mass (SUVlbm), body surface area (SUVbsa), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). The Kaplan–Meier method was used to estimate the progression-free survival (PFS) and overall survival (OS) times. Cox regression models were performed to determinate the relation between qualitative and semiquantitative PET/CT features and OS and PFS.

Results

Thirty-nine patients had positive 18F-FDG PET/CT showing 18F-FDG uptake (mean SUVbw of 18.2; SUVlbm of 13.9; SUVbsa of 5; MTV of 14.8; TLG of 153) at the corresponding cerebral lesion; the remaining 13 were not 18F-FDG avid. Relapse or progression of disease occurred in 22 patients with an average time of 9.7 months; death occurred in 18 patients with an average of 7.9 months. There was no difference in PFS and OS between baseline PET/CT positive and negative groups or considering SUVbw, SUVlbm, and SUVbsa. PFS and OS was significantly shorter in patients with MTV ≥?9.8 cm³ (p?=?0.037 and p?=?0.022, respectively) and TLG ≥?94 (p?=?0.045 and p?=?0.0430, respectively).

Conclusions

18F-FDG avidity was noted in 75% of cases. Only metabolic tumor parameters (MTV and TLG) were independently correlated with PFS and OS.

     

Nonenhancing primary central nervous system lymphoma

Primary central nervous system lymphoma (PCNSL) is rare, although its frequency has increased in recent years. Radiographically, almost all PCNSL enhance on CT and/or MRI, and nonenhancing PCNSL has been thought to be extremely rare. We present PCNSL showing multiple nonenhancing lesions on MRI in an immunocompetent patient.     

Nonenhancing primary central nervous system lymphoma

Primary central nervous system lymphoma (PCNSL) is rare, although its frequency has increased in recent years. Radiographically, almost all PCNSL enhance on CT and/or MRI, and nonenhancing PCNSL has been thought to be extremely rare. We present PCNSL showing multiple nonenhancing lesions on MRI in an immunocompetent patient.     

18F-FDG PET/CT在颅内原发性中枢神经系统淋巴瘤诊断中的价值

目的 探讨18F-FDG PET/CT显像视觉和半定量分析在颅内原发性中枢神经系统淋巴瘤(PCNSL)诊断中的价值。 方法 回顾性分析2011年5月至2018年12月于郑州大学第一附属医院行18F-FDG PET/CT检查的45例颅内PCNSL患者[男性26例、女性19例,年龄（57.49±2.54）岁]的影像资料,并分别与52例脑胶质瘤和60例脑转移瘤患者进行对比,采用视觉分析3组患者的病灶分布和形态特征,半定量分析最大标准化摄取值（SUV_max）、肿瘤与对侧相应部位脑组织SUV_max的比值（T/WM）,评价18F-FDG PET/CT在颅内PCNSL诊断中的价值。2组间半定量结果的比较采用独立样本t检验和校正后t检验,2组间诊断效能的比较及鉴别诊断阈值的判断采用受试者工作特征（ROC）曲线进行分析。 结果 视觉分析结果显示,颅内PCNSL以高摄取18F-FDG的幕上、单发、结节状或团块状病灶为多见,水肿、占位效应及瘤内继发改变不明显。半定量分析结果显示,与脑胶质瘤和脑转移瘤相比,颅内PCNSL的SUV_max最高（脑胶质瘤:9.96±0.48;脑转移瘤:11.97±0.58;颅内PCNSL:26.42±1.17,t=13.02、11.07,均P=0.000）,T/WM亦最高（脑胶质瘤:2.99±0.09;脑转移瘤:2.60±0.08;颅内PCNSL:4.37±0.10,t=10.13、13.88,均P=0.000）,且差异均有统计学意义。当SUV_max=15.8时,颅内PCNSL与脑胶质瘤鉴别诊断的ROC曲线下面积（AUC）最大（0.982）,而当SUV_max=16.8时,颅内PCNSL与脑转移瘤鉴别诊断的AUC最大（0.946）;T/WM=3.395为颅内PCNSL与脑胶质瘤鉴别诊断的最佳阈值,T/WM＝3.220为颅内PCNSL与脑转移瘤鉴别诊断的最佳阈值。 结论 18F-FDG PET/CT显像可以作为传统影像学诊断颅内PCNSL的有效补充,同时在颅内PCNSL与脑胶质瘤和脑转移瘤的鉴别诊断方面具有显著优势。     

Imaging of primary central nervous system lymphoma

Primary central nervous system lymphoma (PCNSL) comprises 5% of all primary brain tumours. PCNSL demonstrates a variety of well-documented imaging findings, which can vary depending on immune status and histological type. Imaging features of PCNSL may overlap with other tumours and infection making definitive diagnosis challenging. In addition, several rare variants of PCNSL have been described, each with their own imaging characteristics. Advanced imaging techniques including 2-[(18)F]-fluoro-2-deoxy-d-glucose ((18)FDG) and (11)C?positron-emission tomography (PET), (201)Tl single-photon emission computed tomography (SPECT), (1)H-magnetic resonance spectroscopy (MRS), and MR perfusion, have been used to aid differentiation of PCNSL from other tumours. Ultimately, no imaging method can definitively diagnose PCNSL, and histology is required.     

18F-FDG PET显像在恶性淋巴瘤中的应用

18F-FDG(18F-氟代脱氧葡萄糖)PET显像作为一种功能显像技术,能反映肿瘤组织中的生化变化和代谢状态,对淋巴瘤的准确分期、恶性程度评价、治疗疗效评价、治疗后复发的诊断以及预后估计等方面均具有重要作用.     

原发性中枢神经系统淋巴瘤的磁共振成像表现

目的探讨原发性中枢神经系统淋巴瘤（PCNSL）的磁共振成像（MRI）特征及鉴别诊断。方法回顾性分析15例经手术病理证实的PCNSL的MRI表现。结果病理检查均为B细胞来源的弥漫性大B细胞性淋巴瘤。15例PCNSL19个病灶,单发13例（87％）,多发2例（13％）共6个病灶。病灶常位于脑表浅部位和近中线部位,T1wI呈等或稍低信号,T2WI及液体衰减反转恢复序列（FLAIR）呈等或稍高信号,弥散加权成像（DWI）呈高信号。所有病灶均明显强化,增强后病灶大多呈均匀实质团块状或结节状强化,典型的可出现“尖角征”、“握拳征”,3例可见小囊变,呈“硬环征”。结论PCNSL的MRI表现具有一定的特征性,术前MRI检查有助于诊断及鉴别诊断,结合患者影像学及临床资料,术前可作出明确诊断。     

原发性中枢神经系统淋巴瘤的影像学表现

目的：探讨原发性中枢神经系统淋巴瘤的影像学表现,以提高影像诊断水平。方法回顾性分析25例经病理证实的原发性中枢神经系统淋巴瘤的CT、MRI等影像学资料。结果单发16例,多发9例,共有39个病灶,幕上35个病灶,幕下4个病灶。单发病灶多位于脑白质深部,多发病灶常位于脑实质中线部位及大脑凸面。肿瘤在CT表现呈稍高密度,病灶T1WI多呈等或稍低信号,T2WI多呈等或稍高信号,DWI多呈高信号。增强扫描多呈明显均匀强化,少数呈斑片状强化;瘤周可见不同程度的水肿。结论原发性中枢神经系统淋巴瘤的CT、MRI表现具有一定特征性,结合临床并综合其影像学表现,可提高其诊断准确率。     

原发性中枢神经系统淋巴瘤的影像学诊断

原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)即是原发于脑、脑脊膜、脊髓、眼球等处的恶性非霍奇金淋巴瘤(non-Hodgkin,s lymphoma,NHL),发病率有逐渐增高的趋势.临床工作中此类肿瘤与其他脑肿瘤鉴别困难,本文总结分析经手术病理证实的原发性颅内恶性淋巴瘤16例,总结分析其影像学表现,提高对该病认识. 1资料与方法 1.1 一般资料 收集本院2009-2012年经手术或穿刺后经病理证实为大脑非霍奇金淋巴瘤16例,临床观察6个月无脑外淋巴结肿大,均排除继发型淋巴瘤.术前9例行CT平扫,其中7例行CT增强检查;16例行磁共振平扫加增强.16例中男12例,女4例,年龄17～75岁,平均50.5岁,病程3 d～5个月不等.本组患者人类免疫缺陷病毒(HIV)抗体均为阴性、无器官移植后免疫抑制剂使用史.临床症状表现为头晕、头痛、恶心、呕吐10例,肢体乏力、偏瘫5例,神经精神紊乱1例.     

10例颅内原发性恶性淋巴瘤18F-FDGPET显像及与MRI比较

目的 分析颅内原发性恶性淋巴瘤（IPML）^18F—FDG PET显像特征。方法 IPML10例，胶质母细胞瘤加例，脑转移瘤15例。分析各自的^18F—FDG PET显像，总结IPML病灶的分布、代谢特点以及病灶周围组织的^18F—FDG分布，计算并比较各组的肿瘤灶／对侧相应部位（T／CCR）放射性比值和肿瘤灶周围皮质／对侧相应部位皮质（TSC／CCRC）放射性比值。结果 10例IPML包括6例单病灶和4例多病灶，单病灶分布于皮质表面，多病灶多分布于脑中线和脑室周围。与对侧相应部位比较，9例病灶呈团块状^18F—FDG摄取明显增高，1例呈环形^18F—FDG浓聚。高代谢灶周围的皮质呈轻度或中度代谢减低；位于基底节和丘脑区域病灶周围未见代谢减低区。与胶质母细胞瘤和脑转移瘤比较，IPML对^18F—FDG摄取程度高于胶质母细胞瘤（P〈0．05），明显高于脑转移瘤（P〈0．01）。IPML病灶周围皮质对^18F—FDG摄取减低程度低于脑转移瘤（P〈0．05），明显低于胶质母细胞瘤（P〈0．01）。结论 IPML病灶呈明显代谢增高，对^18F—FDG摄取程度高于胶质母细胞瘤和脑转移瘤，病灶周围皮质对^18F—FDG摄取减低程度低于胶质母细胞瘤和脑转移瘤。     

18F-氟代脱氧葡萄糖PET及PET-CT在淋巴瘤中的临床应用

PET 在淋巴瘤的分期、再分期、疗效评价及预后判断中具有重要价值,PET-CT则集中了PET的功能显像与CT的解剖显像的双重优势,对淋巴瘤病灶的定位、定性诊断的准确性更高.     

(18)F-FDG PET/CT in bilateral primary adrenal T-cell lymphoma

Primary adrenal lymphoma is extremely rare. We report a young patient who presented with non- specific symptoms of fever and abdominal pain. Conventional imaging modalities demonstrated bilateral bulky adrenal masses, and whole-body fluorine-18-fluorodesoxyglucose ((18)F-FDG) positron emission tomography/computed tomography showed intense (18)F-FDG-avid bilateral adrenal masses with no evidence of extra-adrenal spread. A pathological diagnosis of non-Hodgkin lymphoma of peripheral T-cell type was made. The present case indicates that primary adrenal lymphoma should be included in the differential diagnosis of bilateral adrenal masses.     

18F-氟代脱氧葡萄糖PET及PET-CT在淋巴瘤中的临床应用

PET 在淋巴瘤的分期、再分期、疗效评价及预后判断中具有重要价值,PET-CT则集中了PET的功能显像与CT的解剖显像的双重优势,对淋巴瘤病灶的定位、定性诊断的准确性更高.     

原发性中枢神经系统淋巴瘤MRI表现分析

目的探讨原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)的MRI表现,提高诊断水平。方法回顾性分析我院经病理证实的14例PCNSL患者的MRI资料。14例患者均进行MRI平扫及增强扫描,其中3例患者行MRS。由两名资深MRI诊断医师对MRI图像进行分析,包括病灶的部位、数目、信号特点、强化方式、瘤周水肿、囊变坏死、出血及MRS等。结果1)病灶数目14例患者中单发12例,多发2例,单发病例中有2例病变跨越两个脑叶,1例病变位于左侧小脑半球-小脑蚓部;2)病灶分布右额叶5个,左额叶5个,左顶叶2个,胼胝体2个,左侧大脑脚1个,左侧基底节2个,左右颞叶各1个,左侧小脑半球2个;3)信号特点等T110个,稍长/长T19个;等T28个,稍长/长T211个;DWI稍高信号8个,高信号11个;4)强化特点不均匀强化3例,明显均匀强化11例,软脑膜强化3例,2例多发病例中所有病灶均明显均匀强化;5)瘤周水肿重度水肿2个,中度水肿3个,轻度水肿14个;6)出血及囊变出血2个,囊变2个。结论增强、弥散加权成像联合瘤周水肿对PCNSL的诊断有重要价值,MRS对鉴别诊断有一定的作用。     

Use of F-18 FDG PET/CT in non-Hodgkin lymphoma with central nervous system involvement

Central nervous system (CNS) is a rare site of involvement by non-Hodgkin lymphoma (NHL). Therapeutic approach for primary and secondary CNS NHL is different and remains challenging. Therefore imaging data are essential at staging to discriminate these 2 clinical entities and during follow-up to assess therapy response. The adjunct role of positron emission tomography using F-18 fluorodeoxyglucose to morphologic imaging is still undefined. We report 2 didactic cases of primary and secondary CNS NHL assessed by F-18 fluorodeoxyglucose positron emission tomography. Metabolic imaging seems to be complementary to conventional imaging techniques for the extent-of-disease evaluation and therapy monitoring of CNS lesions.