Skip to main content
SpringerLink
Log in

Increased 18F-FDG accumulation in the tonsils after chemotherapy for pediatric lymphoma: a common physiological phenomenon

  • Short Communication
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objective

Increased 18F-fluorodeoxyglucose (FDG) uptake in the tonsils after the completion of chemotherapy in patients with lymphoma may be misdiagnosed as tumor recurrence. This study aimed to investigate the changes in physiological FDG uptake in the tonsils during and after chemotherapy in pediatric patients with lymphoma.

Methods

A total of 47 FDG-PET/CT scans acquired from 13 pediatric patients with lymphoma (before chemotherapy [preC] = 9; during chemotherapy [durC] = 12; within 1 month after the end of chemotherapy [endC] = 11; and after achieving complete response [postC] = 15) were retrospectively included in this study. FDG uptake in the palatine tonsils was assessed using maximum standardized uptake value (SUVmax). The relative size of the palatine tonsils was calculated as the tonsil-pharyngeal ratio (TPR). Serial changes in the SUVmax and TPR were evaluated.

Results

The mean SUVmax was 3.7 ± 1.7, 2.6 ± 0.7, 2.3 ± 0.8, and 6.2 ± 1.6, at the preC, durC, endC, and postC scans, respectively (p < 0.0001); TPR was 59.0 ± 11.2%, 58.3 ± 9.4%, 54.4 ± 7.9%, and 62.2 ± 12.0% in these groups, respectively, with no significant inter-group differences. TPR and SUVmax showed no correlation.

Conclusions

Increased physiological FDG uptake in the tonsils is commonly observed after the completion of chemotherapy, even in the absence of reactive hypertrophy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Cheson BD. New staging and response criteria for non-Hodgkin lymphoma and Hodgkin lymphoma. Radiol Clin N Am. 2008;46:213–23 vii.

    Article  PubMed  Google Scholar 

  2. Cheson BD. Role of functional imaging in the management of lymphoma. J Clin Oncol. 2011;29:1844–54.

    Article  PubMed  Google Scholar 

  3. Seam P, Juweid ME, Cheson BD. The role of FDG-PET scans in patients with lymphoma. Blood. 2007;110:3507–16.

    Article  CAS  PubMed  Google Scholar 

  4. Burrell S, Van den Abbeele AD. 2-Deoxy-2-[F-18] fluoro-D-glucose-positron emission tomography of the head and neck: an atlas of normal uptake and variants. Mol Imaging Biol. 2005;7:244–56.

    Article  PubMed  Google Scholar 

  5. Shammas A, Lim R, Charron M. Pediatric. FDG PET/CT: physiologic uptake, normal variants, and benign conditions. Radiographics. 2009;29:1467–86.

    Article  PubMed  Google Scholar 

  6. Nakatani K, Nakamoto Y, Watanabe K, Saga T, Higashi T, Togashi K. Roles and limitations of FDG PET in pediatric non-Hodgkin lymphoma. Clin Nucl Med. 2012;37:656–62.

    Article  PubMed  Google Scholar 

  7. Chen CH, Hsiao CC, Chen YC, Ko SF, Huang SH, Hsieh KS, et al. Rebound thymic hyperplasia after chemotherapy in children with lymphoma. Pediatr Neonatol. 2017;58:151–7.

    Article  CAS  PubMed  Google Scholar 

  8. Kaste SC, Howard SC, McCarville EB, Krasin MJ, Kogos PG. Hudson MM 18F-FDG-avid sites mimicking active disease in pediatric Hodgkin’s. Pediatr Radiol. 2005;35:141–54.

    Article  PubMed  Google Scholar 

  9. Hudson MM, Krasin MJ, Kaste SC. PET imaging in pediatric Hodgkin’s lymphoma. Pediatr Radiol. 2004;34:190–8.

    Article  PubMed  Google Scholar 

  10. Goethals I, Hoste P, De Vriendt C, Smeets P, Verlooy J, Ham H. Time-dependent changes in 18F-FDG activity in the thymus and bone marrow following combination chemotherapy in paediatric patients with lymphoma. Eur J Nucl Med Mol Imaging. 2010;37:462–7.

    Article  PubMed  Google Scholar 

  11. Weinblatt ME, Zanzi I, Belakhlef A, Babchyck B, Kochen J. False-positive FDG-PET imaging of the thymus of a child with Hodgkin’s disease. J Nucl Med. 1997;38:888–90.

    CAS  PubMed  Google Scholar 

  12. Hosokai R, Imai C, Takachi T, Yoshida S, Iwabuchi H, Imamura M. Reactive tonsillar enlargement with strong 18F-FDG uptake after chemotherapy for tonsillar diffuse large B-cell lymphoma. J Pediatr Hematol Oncol. 2011;33:e87–8.

    Article  PubMed  Google Scholar 

  13. Feio P di SQ, Gomes CBF, Nogueira AS, Almeida LY, Vassallo J, Soares FA, et al. Reactive tonsillar enlargement showing strong 18F-FDG uptake during the follow-up of follicular lymphoma. Head Neck Pathol. 2013;7:258–62.

    Article  Google Scholar 

  14. Oguz A, Karadeniz C, Citak EC, Conly NA, Ileri F, Boyunaga O, et al. Thymic and adenotonsillar enlargement after successful treatment of malignancies. Pediatr Hematol Oncol. 2005;22:423–35.

    Article  PubMed  Google Scholar 

  15. Tokuc G, Oktem S, Genc A. Nasopharyngeal lymphoid hyperplasia after therapy for childhood lymphomas. Acta Oncol. 2006;45:618–20.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was partly supported by the grants as a commissioned research (K.Y was received from Nihon Medi-Physics Co. Ltd). We thank Editage (http://www.editage.jp) for English language editing.

Author information

Authors and Affiliations

  1. Division of PET Imaging, Shiga Medical Center Research Institute, 5-4-30, Moriyama, Moriyama, Shiga, 524-8524, Japan

    Chio Okuyama

  2. Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kamigyo-ku, Kyoto, 602-8566, Japan

    Chio Okuyama, Shigenori Matsushima, Motoki Nishimura & Kei Yamada

Authors
  1. Chio Okuyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shigenori Matsushima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Motoki Nishimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kei Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chio Okuyama.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Okuyama, C., Matsushima, S., Nishimura, M. et al. Increased 18F-FDG accumulation in the tonsils after chemotherapy for pediatric lymphoma: a common physiological phenomenon. Ann Nucl Med 33, 368–373 (2019). https://doi.org/10.1007/s12149-019-01337-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12149-019-01337-w

Keywords

Search

Navigation