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FDG avidity and PET/CT patterns in primary gastric lymphoma

  • Lea Radan
  • Doron Fischer
  • Rachel Bar-Shalom
  • Eldad J. Dann
  • Ron Epelbaum
  • Nissim Haim
  • Diana Gaitini
  • Ora IsraelEmail author
Original Article

Abstract

Purpose

The use of 18F-fluoro-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in primary gastric lymphoma (PGL) is challenging due to physiologic FDG activity in the stomach and variability in the degree of uptake in various histologic subtypes. This study assesses FDG avidity and PET/CT patterns in newly diagnosed PGL.

Methods

Sixty-two PET/CT studies of newly diagnosed PGL were reviewed (24 low-grade mucosa-associated lymphoid tissue [MALT], 38 aggressive non-Hodgkin’s lymphoma [AGNHL]). FDG avidity, patterns (focal/diffuse), and intensity (visually vs. the liver and SUVmax) were assessed and compared to 27 controls. Gastric CT abnormalities and extragastric sites were recorded.

Results

Gastric FDG uptake was found in 55/62 (89%) PGL (71% MALT vs. 100% AGNHL, p < 0.001) and 63% controls. A diffuse pattern was found in 60% PGL (76% MALT vs. 53% AGNHL, p = NS) and 47% controls. FDG uptake higher than liver was found in 82% PGL (58% MALT vs. 97% AGNHL, p < 0.05) and 63% controls. SUVmax in FDG-avid PGLs was 15.3 ± 11.7 (5.4 ± 2.9 MALT vs. 19.7 ± 11.5 AGNHL, p < 0.001) and 4.6 ± 1.4 in controls. CT abnormalities were found in 79% PGL (thickening, n = 49; ulcerations, n = 22). Extra-gastric FDG-avid sites were seen in none of MALT, but 61% of AGNHL (nodal, n = 18; nodal and extranodal, n = 5).

Conclusions

FDG avidity was present in 89% of PGLs, including all patients with AGNHL but only 71% of MALT. FDG uptake can be differentiated, in particular in AGNHL-PGL, from physiologic tracer activity by intensity but not by pattern. Extragastric foci on PET and structural CT abnormalities are additional parameters that can improve PET/CT assessment of PGL. Defining FDG avidity and PET/CT patterns in AGNHL and a subgroup of MALT-PGL before treatment may be important for further monitoring therapy response.

Keywords

Gastric lymphoma PET/CT FDG 

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Lea Radan
    • 1
  • Doron Fischer
    • 2
  • Rachel Bar-Shalom
    • 3
  • Eldad J. Dann
    • 4
  • Ron Epelbaum
    • 5
  • Nissim Haim
    • 5
  • Diana Gaitini
    • 6
  • Ora Israel
    • 3
    Email author
  1. 1.Department of Nuclear MedicineRambam Health Care CampusHaifaIsrael
  2. 2.Department of Diagnostic ImagingRambam Health Care CampusHaifaIsrael
  3. 3.Department of Nuclear Medicine, Rambam Health Care Campus and R. and B. Rappaport School of Medicine Technion—Israel Institute of TechnologyHaifaIsrael
  4. 4.Department of Hematology, Rambam Health Care Campus, and R. and B. Rappaport School of MedicineTechnion—Israel Institute of TechnologyHaifaIsrael
  5. 5.Department of Oncology, Rambam Health Care Campus, and R. and B. Rappaport School of MedicineTechnion—Israel Institute of TechnologyHaifaIsrael
  6. 6.Department of Diagnostic ImagingRambam Health Care Campus, and R. and B. Rappaport School of Medicine, Technion—Israel Institute of TechnologyHaifaIsrael

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