Endoscopic features and prognoses of mantle cell lymphoma with gastrointestinal involvement

AIM: To evaluate the endoscopic manifestations and prognoses of gastrointestinal (GI) mantle cell lymphoma (MCL). METHODS: A database search at the Department of Pathology of Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences revealed 57 MCL patients with GI involvement. Clinical records were available for 35 of the 57 patients from 21 institutions, and those 35 patients were enrolled in this study. We summarized the gross types of endoscopic features, event-free survival...     

Multiple primary malignant tumors of upper gastrointestinal tract: A novel role of 18F-FDG PET/CT

AIM: To evaluate the capacity of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for detecting multiple primary cancer of upper gastrointestinal (UGI) tract. METHODS: Fifteen patients (12 without cancer histories and 3 with histories of upper GI tract cancer) were investigated due to the suspicion of primary cancer of UGI tract on X-ray barium meal and CT scan. Subsequent whole body 18F-FDG PET/CT scan was carried out for initial staging or restaging. All the patient...     

F-FDG PET/CT诊断胆管细胞癌分期价值研究

目的 探讨采用¹⁸F-氟代脱氧葡糖糖(¹⁸F-FDG)正电子发射计算机断层扫描(PET/CT)诊断肝内胆管细胞癌(ICC)分期的效能。方法 2017年1月～2020年1月我院收治的107例ICC患者和同期107名体检且身体健康的志愿者,接受¹⁸F-FDG PET/CT检查,行TNM分期评估,勾画感兴趣区域,计算最大标准摄取值(SUV_max)。所有患者接受手术治疗,术后行组织病理学检查。结果 Ⅰ期ICC组SUV_max值为(4.1±1.1)、Ⅱ期为(7.2±1.5)、Ⅲ期为(9.3±1.8),均显著高于健康组的【(2.0±0.9),P＜0.05】;¹⁸F-FDG PET/CT检查显示在107例ICC患者中,TNM分期Ⅰ期为35例,Ⅱ期为47例,Ⅲ期为25例,术后组织病理学检查显示Ⅰ期、Ⅱ期和Ⅲ期分别为34例、48例和24例;经一致性分析,¹⁸F-FDG PET/CT诊断ICC患者TNM Ⅰ期的灵敏度为0.968,特异度为0.500,准确率为0.914,阳性预测值为0.938,阴性预测值为0.667,诊断Ⅱ期的灵敏度为0.976,特异度为0.667,准确率为0.956,阳性预测值为0.976,阴性预测值为0.667,诊断Ⅲ期的灵敏度为0.955,特异度为0.667,准确率为0.920,阳性预测值为0.955,阴性预测值为0.667。结论 ¹⁸F-FDG PET/CT检查能够帮助诊断ICC,并协助TNM分期的评估,具有较高的临床应用价值。     

硬化性肺细胞瘤的MSCT特征及18F-FDGPET/CT表现

目的分析肺硬化性肺细胞瘤(pulmonary sclerosing pneumocytoma, PSP)的临床特征、多层螺旋CT(multislice spiral computed tomography, MSCT)和¹⁸F-FDGPET/CT特征，提高PSP术前诊断水平及认识。 方法选择2013年9月至2021年11月我院经手术病理证实后55例PSP患者，分析临床及影像学特征，包括48例CT平扫、33例CT增强、19例¹⁸F-FDGPET/CT全身显像，进一步分析病灶分布、形态、大小、伴随征象、代谢摄取结果，进一步分析了病灶最大直径与最大标准化摄取值(SUV_max)相关性。 结果MSCT显示病灶多为单发(94.5%)，边界光滑(89%)，呈圆形或椭圆形(85.5%)，平均直径25.6 mm。CT主要征象包括贴边血管征(45.5%)、晕征(12.7%)、空气新月征(16.4%)和钙化(41.8%)。增强扫描延迟期趋向均匀持续强化。19例PSP病灶SUV_max，平均值为(2.87±1.20)，病灶SUV_max与最大长径呈显著正相关(R＝0.51，P<0.001)。 结论"血管贴边征"、"空气新月征"、"晕征"、"钙化"等特征性PSP患者具有特征性MSCT表现，PSP病灶¹⁸F-FDG PET/CT以中低代谢摄取为主，其大小可能与摄取FDG增加有关，MSCT影像征象、¹⁸F-FDG PET/CT代谢摄取为正确诊断PSP提供了理论依据。     

18F-FDG PET/CT imaging in the diagnosis of drug-induced lung disease and pulmonary infection in lymphoma

Objective:Lymphoma is a hematological disease with high prevalence. Multi-cycle chemotherapy (CHT) or local radiotherapy is applied usually; however, adverse events have been reported, such as drug-induced lung disease (DILD). Positron emission tomography/computed tomography (PET/CT) is often used to evaluate the lesion, treatment effect, and prognosis of lymphoma. We investigated DILD and pulmonary infection (PI) after multi-cycle CHT in lymphoma patients, to identify DILD and PI, provide guidance for later treatment for them.Methods:In all, 677 patients diagnosed with lymphoma and who underwent CHT were included. These patients underwent ¹⁸fluorodeoxyglucose (¹⁸F-FDG) PET/CT before and after CHT at Shandong Cancer Hospital (affiliated with Shandong University) between April 2015 and November 2019. Fifty patients developed DILD, 41 patients had lung infections; lesion characteristics were analyzed based on clinical characteristics, laboratory examinations, and PET/CT imaging.Results:Among the 677 lymphoma patients, there were 50 cases of DILD, with an incidence rate of 7.4%. PET/CT showed an elevated ¹⁸fluorodeoxyglucose uptake lung background, septal thickening and reticulation, multiple ground glass-like shadows, and grid-shaped blur shadows, which were more common in the lung periphery and under the pleura. The maximum standardized uptake value in the lung was 2.45 ± 0.52. Pulmonary infections occurred in 41 patients, and the maximum standardized uptake value was 4.05 ± 1.42. Age, sex, CHT cycle, Ann-Arbor stage, and lymphocyte levels were not significantly different between DILD and PI patients. Leukocyte and neutrophils showed significant differences; the PI patients had increased laboratory indexes of leukocyte and neutrophils. The mean number of CHT cycles was 4 cycles for DILD and PI.Conclusions:PET/CT imaging has high sensitivity and detection rates for primary and metastatic lymphoma lesions. DILD mostly occurs in the middle and late stages of CHT. Laboratory tests and PET/CT can evaluate the lesions and treatment effects, and provide guidance for subsequent treatment plans for patients.     

Metabolic restaging of hepatocellular carcinoma using whole-body 18F-FDG PET/CT

AIM: To evaluate the ability of ¹⁸F-fluorodeoxyglucose positron emission and computed tomography (¹⁸F-FDG PET/CT) in restaging of hepatocellular carcinoma (HCC) after treatment.METHODS: We reviewed a database of the diagnostic performance of ¹⁸F-FDG PET/CT scan for patients with HCC following local or regional treatment. The database consisted of ¹⁸F-FDG PET/CT information of 21 male and 4 female (age range, 27-81 years; mean age, 51.6 years) patients who had received surgical resection and/or interventional treatments and then underwent ¹⁸F-FDG PET/CT scan. All patients had received enhanced CT scan of the liver two weeks before or after the ¹⁸F-FDG PET/CT scan. Intrahepatic recurrence and/or extrahepatic metastases were confirmed by histological analysis or clinical and imaging follow-up. The accuracy of ¹⁸F-FDG PET/CT study was determined by histopathological results or by clinical and imaging follow-up.RESULTS: ¹⁸F-FDG PET/CT was abnormal in 19 of the 25 (76.0%) patients. In detecting HCC recurrence, ¹⁸F-FDG PET/CT scored 17 true positives, 5 true negatives, 2 false positives and 1 false negative. The sensitivity, specificity and accuracy of ¹⁸F-FDG PET/CT in detecting HCC recurrence was 89.5%, 83.3% and 88%, respectively. ¹⁸F-FDG PET/CT had an impact on management of these patients by settling the problem of an unexplained increase in alpha-fetoprotein after treatment (14 patients), by monitoring response to the treatment and guiding additional regional therapy (12 patients), by identifying extrahepatic metastases (10 patients), by identifying tumor growth or thrombosis in the portal vein (6 patients), or by guiding surgical resection of extrahepatic metastases (2 patients).CONCLUSION: Our results suggest that whole body ¹⁸F-FDG PET/CT may be useful in the early evaluation of residual, intrahepatic recurrent or extrahepatic metastatic lesions and able to provide valuable information for the management of HCC recurrence.     

Lung cancer combined with diffuse peritoneal and mesenteric amyloidosis detected on 18F-FDG PET/CT: A case report

Rationale:Amyloidosis is a heterogeneous group of diseases characterized by extracellular deposition of amyloid fibrils. Lung carcinoma is rarely reported to be associated with AA amyloidosis. With regard to the manifestation of amyloidosis infiltrating organs, most of the cases focus on the heart, liver, kidneys, and peripheral nervous system. Amyloidosis with diffuse abdominal involvement in combination with pulmonary squamous cell carcinoma carcinoma is an exceptionally rare occurrence.Patient concerns:A 70-year-old man was admitted to hospital for a 2-month history of repeated cough, low grade fever, hemoptysis and left back shoulder pain, which was not relieved by nonsteroid anti-inflammatory drugs. Meanwhile, he complained of intermittent diffuse abdominal discomfort and chronic persistent constipation.Diagnoses:The patient was diagnosed with poorly differentiated lung squamous cell carcinoma and diffuse peritoneal and mesenteric amyloidosis based on the pathological biopsy.Interventions:The patient received surgery and chemotherapy for lung tumor. He did not receive any treatment against amyloidosis.Outcomes:The patient died of a severe respiratory infection.Lessons:This case indicates that lung carcinoma is suspected to play a causative role in the development of amyloidosis. In addition, amyloidosis should be considered in the differential diagnosis in cases in which diffuse greater omentum, peritoneal, and mesenteric calcifications on ¹⁸F-2-fluoro-2-deoxy-D-glucose(¹⁸F-FDG) photon emission computed tomography (PET/CT).     

18F-fluorodeoxyglucose PET/CT findings of a solitary primary hepatic lymphoma: A case report

Primary hepatic lymphoma is extremely rare, and only a few cases have been described on positron emission tomography (PET) or PET/computed tomography (PET/CT) imaging in the English literature. We report a case of a 55-year-old woman who presented with low-grade fever and weight loss of three months. On CT scanning, a mass was identified which appeared to be a hypoattenuating lesion, on ultrasonographic imaging, the mass was hypoechoic, therefore, liver abscess or hepatic metastasis from a gastrointestinal primary was initially suspected. Tumor markers such as alpha-fetoprotein, carcinoembryonic antigen and carbohydrate antigen 19-9 were within normal limits. PET/CT demonstrated a large abnormal ring-like hypermetabolic focus in the right liver lobe. The lesion was resected and the histopathological findings were consistent with lymphoma. The patient was discharged two weeks after surgery and did not receive any further treatment. After 25 mo follow-up, she is in good health. ¹⁸F-fluorodeoxyglucose PET/CT is useful in confirming the diagnosis of primary hepatic lymphoma by demonstrating no other foci with high uptake in other parts of the body.     

Comparison of 18F-FDG PET/CT imaging with different dual time 18F-FDG PET/CT with forced diuresis in clinical diagnosis of prostate cancer

The aim of this study was to compare the capability of different dual time (interval 1, 2, 3, or 4 hours) 18F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) with forced diuresis to diagnose prostate cancer (PCa). A retrospective review of 273 male patients from March 2009 to June 2019, with any focal ¹⁸F-FDG uptake in the prostate gland during PET/CT imaging. Early PET/CT imaging was performed 60 minutes after FDG injection. Delayed imaging was performed 1 to 4 hours after diuretic injection. For prostate lesions with increased ¹⁸F-FDG uptake, a spheroid-shaped volume of interest was drawn, including the entire lesion, and the maximum standard uptake value (SUVmax) of the lesion was measured. The SUVmax > 2.5 after delayed imaging and the retention index > 15% were used as the diagnostic criteria for PET/CT in the diagnosis of PCa. Otherwise, it was diagnosed as the benign prostate disease. The final diagnosis was based on histological examination, associated imaging studies, or/and clinical follow-up. The results of inter-group comparison showed that the SUVmax of 1-, 2-, 3-, and 4-hour delayed imaging after diuresis in PCa group was significantly higher than that in control group (P < .05), but there was no statistical difference in SUVmax of early imaging between PCa and control group (P > .05). And the retention index of PCa group that delayed 1, 2, 3, and 4 hours after diuresis were significantly higher than those of control group, respectively (P < .05). The diagnostic sensitivity of imaging delayed 1, 2, 3, and 4 hours after diuresis was 68.8%, 81.2%, 85.7 %, and 71.4%, the specificity was 52.5%, 74.5%, 70.6%, and 65.0%, and the accuracy was respectively 58.2%, 77.4%, 76.4%, and 67.6%, the positive predictive values were 44.0%, 68.9%, 64.3%, and 58.8%, and the negative predictive value were 75.6%, 85.4%, 88.9%, and 76.5%, respectively. ¹⁸F-FDG PET/CT imaging as an imaging tool lacks certain specificity in the diagnosis of PCa, regardless of whether the imaging is delayed. The main advantage of delayed diuretic imaging in PCa is that it can significantly improve the sensitivity, especially the diagnostic effect delayed 2 hours after diuresis is better.     

Clinical value of 18F-fluoro-dexoxyglucose positron emission tomography/computed tomography in patients with adult-onset Still's disease: A seven-case series and review of the literature

Abstract

Objectives. While there are a few reports describing 18F-fluoro-dexoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) findings in patients with adult-onset Still's disease (AOSD), no summary report has yet been published. In this study, we evaluated the usefulness of FDG-PET/CT for diagnosis and activity evaluation in patients with AOSD by summarizing the findings of our patients and those reported in the literature.

Methods. Seven consecutive AOSD patients who had undergone PET/CT at our department between 2007 and 2012 were included. We evaluated FDG uptake for characteristic findings in patients with AOSD. In addition, we reviewed the literature on seven previously reported AOSD patients who had undergone PET/CT.

Results. FDG accumulation was positive mainly in the bone marrow (100%), spleen (90.9%), lymph nodes (80.0%) and joints (75.0%). In addition, FDG uptake was positive in the pericardium, pleura, salivary glands, eyelids, muscle and major blood vessels. Six patients underwent follow-up FDG PET/CT for evaluation of treatment efficacy. Follow-up PET/CT showed diminished FDG accumulation in the bone marrow, spleen and lymph nodes, with maximum standardized uptake value (SUV_max) being substantially reduced from 4.03 ± 0.95 to 2.20 ± 0.75 (p = 0.04), 4.04 ± 1.10 to 2.55 ± 1.13 (p = 0.04) and 5.63 ± 4.99 to 2.10 ± 1.91 (p = 0.11), respectively. No significant correlation was found between SUV_max in each lesion and the laboratory data, except for a significant correlation between lactate dehydrogenase (LDH) and spleen SUV.

Conclusions. FDG-PET/CT is useful for long-term assessments of AOSD activity in individual patients. However, PET/CT findings alone are not sufficient to make a differential diagnosis of AOSD versus malignant lymphoma.     

Diagnostic value for extrahepatic metastases of hepatocellular carcinoma in positron emission tomography/computed tomography scan

AIM: To evaluated the value of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) scan in diagnosis of hepatocellular carcinoma (HCC) and extrahepatic metastases.METHODS: A total of 138 patients with HCC who had both conventional imaging modalities and ¹⁸F-FDG PET/CT scan done between November 2006 and March 2011 were enrolled. Diagnostic value of each imaging modality for detection of extrahepatic metastases was evaluated. Clinical factors and tumor characteristics including PET imaging were analyzed as indicative factors for metastases by univariate and multivariate methods.RESULTS: The accuracy of chest CT was significantly superior compared with the accuracy of PET imaging for detecting lung metastases. The detection rate of metastatic pulmonary nodule ≥ 1 cm was 12/13 (92.3%), when < 1 cm was 2/10 (20%) in PET imaging. The accuracy of PET imaging was significantly superior compared with the accuracy of bone scan for detecting bone metastases. In multivariate analysis, increased tumor size (≥ 5 cm) (P = 0.042) and increased average standardized uptake value (SUV) uptake (P = 0.028) were predictive factors for extrahepatic metastases. Isometabolic HCC in PET imaging was inversely correlated in multivariate analysis (P = 0.035). According to the receiver operating characteristic curve, the optimal cutoff of average SUV to predict extrahepatic metastases was 3.4.CONCLUSION: ¹⁸F-FDG PET/CT scan is invaluable for detection of lung metastases larger than 1 cm and bone metastases. Primary HCC having larger than 5 cm and increased average SUV uptake more than 3.4 should be considered for extrahepatic metastases.     

Pulmonary cavitations with increased 18F-FDG uptake revealing a thoracic endometriosis: A case report

Rationale:Thoracic endometriosis is a rare disorder that can involve airways, pleura and lung parenchyma. It is the most frequent form of extra-abdominopelvic endometriosis. Multiple lung cavitations are a rare feature of thoracic endometriosis.Patient concerns:A 46-year-old woman was referred to our hospital after incidental finding of multiple pulmonary cavitations with surrounding areas of ground glass opacity on a thoraco-abdominal computed tomography-scan performed for abdominal pain. Retrospectively, the patient also reported mild hemoptysis occurring 4 months ago.Diagnoses:Positron emission tomography–computed tomography scan revealed moderate and homogeneous [¹⁸F] fluoro-2-deoxy-D-glucose (¹⁸F-FDG) uptake in pulmonary cavitations (maximum standardized uptake value 5.7). The diagnosis of thoracic endometriosis was confirmed by histological examination of surgical resection of a left lower lobe cavitation.Interventions and outcome:Gonadotropin-releasing hormone analogues associated with add-back therapy was started. Four months after initiating pharmacological treatment, the chest computed tomography-scan showed a dramatic decrease in lung cavitations size.Lessons:Thoracic endometriosis is a rare disorder requiring a multidisciplinary management including gynaecologist, pulmonologist, radiologist, nuclear physician, pathologist and thoracic surgeon for early diagnosis and treatment. Our case report highlights that an increased ¹⁸F-FDG uptake can be found in thoracic endometriosis syndrome presenting as multiple lung cavitations.     

Prognostic utility of pre-transplantation [18F] fluorodeoxyglucose positron emission tomography/computed tomography in patients with diffuse large B-cell lymphoma who underwent rituximab,dexamethasone, high-dose cytarabine,carboplatin salvage chemotherapy

We analysed the outcomes of 62 patients with refractory/relapsed diffuse large B-cell lymphoma (rrDLBCL) who had pre-transplantation fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) after R-DHAC (rituximab, dexamethasone, high-dose cytarabine, carboplatin) salvage chemotherapy, and were evaluated using Deauville criteria and total lesion glycolysis (TLG). A positive pre-transplantation PET/CT with Deauville score of 5 was associated with shorter progression-free survival (PFS) (P = 0·01), while a Deauville score of 4 was not predictive of outcome. Only pre-transplant TLG was significantly associated with both PFS (P = 0·005) and overall survival (P = 0·03). TLG deserves to be further investigated in prospective studies.     

Necrosis on pre-radiotherapy 18F-FDG PET/CT is a predictor for complete metabolic response in patients with non-small cell lung cancer

To investigate necrosis on pre-radiotherapy (RT) ¹⁸F-FDG PET/CT (PET_NECROSİS) as a predictor of complete metabolic response (CMR) in patients with non-small cell lung cancer (NSCLC).We evaluated patients with inoperable stage I–III NSCLC who underwent pre- and post-radiotherapy ¹⁸F-FDG PET/CT. The relationship between CMR and PET_NECROSIS, SUVmax, gross tumor volume calculated with ¹⁸F-FDG PET/CT (GTV_PET-CT), tumor size, histology, metabolic tumor volume (MTV), and RT dose was assessed using logistic regression analysis. To evaluate necrosis on ¹⁸F FDG PET/CT, we drew a region of interest (ROI) in the area showing visually very low/or no fluorodeoxyglucose (FDG) uptake on PET images. If the SUVmax was lower than the blood pool SUVmax and showed significantly lower attenuation (10–30 Hounsfield units [HU]) from the surrounding tissue on non-intravenous contrast-enhanced low-dose correlative CT, we defined it as necrotic (PET_NECROSİS).Fifty-three patients were included in this study. The mean age was 68.1 ± 9.8 years. Twenty-one patients had adenocarcinoma, and 32 had squamous cell carcinoma. All parameters were independent of histologic status. Multivariate logistic regression analysis showed that SUVmax ≤11.6 vs >11.6, (P = .003; OR, 7.670, 95CI%: 2.013–29.231) and PET_NECROSİS absence/presence were independent predictors for CMR (P = .028, OR: 6.704, 95CI% 1.214–30.394).The necrosis on ¹⁸F FDG PET/CT and SUVmax > 11.6 could be an imaging marker for the complete metabolic response after definitive chemoradiotherapy or definitive RT alone in patients with NSCLC.     

Measurement of brown adipose tissue mass using a novel dual-echo magnetic resonance imaging approach: A validation study

Objective

The aim of this study was to evaluate and validate magnetic resonance imaging (MRI) for the visualization and quantification of brown adipose tissue (BAT) in vivo in a rat model. We hypothesized that, based on differences in tissue water and lipid content, MRI could reliably differentiate between BAT and white adipose tissue (WAT) and could therefore be a possible alternative for ¹⁸ F-Fluorodeoxyglucose Positron Emission Tomography (¹⁸FDG-PET), the current gold standard for non-invasive BAT quantification.

Materials/Methods

Eleven rats were studied using both ¹⁸FDG-PET/CT and MRI (1.5 T). A dual echo (in-and-out-of-phase) sequence was used, both with and without spectral presaturation inversion recovery (SPIR) fat suppression (DUAL-SPIR) to visualize BAT, after which all BAT was surgically excised. The BAT volume measurements obtained via ¹⁸FDG-PET/CT and DUAL-SPIR MR were quantitatively compared with the histological findings. All study protocols were reviewed and approved by the local ethics committee.

Results

The BAT mass measurements that were obtained using DUAL-SPIR MR subtraction images correlated better with the histological findings (P = 0.017, R = 0.89) than did the measurements obtained using ¹⁸FDG-PET/CT (P = 0.78, R = 0.15), regardless of the BAT metabolic activation state. Additionally, the basic feasibility of the DUAL-SPIR method was demonstrated in three human pilot subjects.

Conclusions

This study demonstrates the potential for MRI to reliably detect and quantify BAT in vivo. MRI can provide information beyond that provided by ¹⁸FDG-PET imaging, and its ability to detect BAT is independent of its metabolic activation state. Additionally, MRI is a low-cost alternative that does not require radiation.     

Diagnostic Performance of 18F-FDG PET/CT for Lymph Node Staging in Patients with Operable Non-small-cell Lung Cancer and Inflammatory Lung Disease

As ¹⁸F-fluorodeoxyglucose (FDG) is taken up by inflammatory lymph nodes, it could be falsely interpreted as metastasis. Therefore, we evaluated the diagnostic ability of positron emission tomography/computed tomography (PET/CT) for lymph node staging of lung cancer when inflammatory lung disease coexisted. Patients with operable non-small-cell lung cancer and FDG-avid lymph nodes were retrospectively classified into two groups; those with inflammatory lung disease (ILD) and those without it (NILD). Receiver operating characteristic (ROC) curve analysis was performed for maximum standardized uptake value (SUVmax), pattern of FDG uptake, maximum Hounsfield unit, and size, and then the areas under the ROC curves (AUCs) were compared between subgroups. There were 124 patients (ILD/NILD = 38/86) and 396 FDG-avid lymph nodes (ILD/NILD = 140/256). The average number of FDG-avid lymph nodes was greater in ILD (3.7 vs. 2.9, p = 0.039), whereas the proportion of metastasis was higher in NILD (25.4% vs. 11.4%, p = 0.002). With all N1–N3 lymph nodes and the NILD group, the AUC values of all four parameters were significantly greater than 0.5 (p < 0.05), and SUVmax was the most valuable parameter for lymph node metastasis. However, in the ILD group, only the AUC value of SUVmax was significantly greater than 0.5. These results were reproduced when analyses were performed with N1–N2 lymph nodes. In conclusion, SUVmax was the most valuable PET/CT parameter for assessment of lymph node metastasis in patients with operable non-small-cell lung cancer. In addition, it was the only valuable parameter when inflammatory lung disease coexisted.     

Using 18F-FDG PET/CT to rule out Richter transformation as cause of deterioration in a patient with chronic lymphatic leukemia and severe COVID-19: A case report

Rationale:This case report demonstrates the use of flourine-18 fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/computed tomography (CT) to rule out Richter transformation (RT) as the cause of clinical deterioration in a patient with chronic lymphatic leukemia (CLL) and severe COVID-19. ¹⁸F-FDG PET/CT can be used to establish the diagnosis of RT in patients with CLL, but the use of ¹⁸F-FDG PET/CT to exclude RT as the cause of clinical deterioration in patients with CLL and severe COVID-19 has not previously been described.Patient concerns:A 61-year-old male with CLL and COVID-19 developed increased dyspnea, malaise and fever during hospitalization for treatment of severe and prolonged COVID-19.Diagnoses:¹⁸F-FDG PET/CT ruled out RT and revealed progression of opacities in both lungs consistent with exacerbation of severe acute respiratory syndrome coronavirus 2 pneumonia.Interventions:¹⁸F-FDG PET/CT imaging.Outcomes:The patient was discharged at day 52 without the need of supplemental oxygen, with normalized infection marks and continued care for CLL with venetoclax.Lessons:¹⁸F-FDG PET/CT ruled out RT as the cause of deteriorations in a patient with CLL and severe COVID-19, enabling directed care of exacerbation of severe acute respiratory syndrome coronavirus 2 pneumonia.