18F-FDG PET/CT in gastric MALT lymphoma: a bicentric experience

  • Domenico AlbanoEmail author
  • Mattia Bertoli
  • Paola Ferro
  • Federico Fallanca
  • Luigi Gianolli
  • Maria Picchio
  • Raffaele Giubbini
  • Francesco Bertagna
Original Article



The role of 18F-FDG-PET/CT in evaluating gastric MALT lymphoma is still controversial. In the literature the detection rate of 18F-FDG-PET/CT in patients with gastric MALT lymphoma is variable, and the reason for this heterogeneity is not still clear. Our aim was to investigate the particular metabolic behavior of these lymphoma.

Materials and methods

Sixty-nine patients (26 female, 43 male) with histologically confirmed gastric MALT lymphoma who underwent a 18F-FDG-PET/CT for initial staging from two centers were included. The PET images were analyzed visually and semi-quantitatively by measuring the maximum standardized uptake value (SUVmax), lesion-to-liver SUVmax ratio, and lesion-to-blood pool SUVmax ratio and compared with Ann Arbor stage, epidemiological (age, sex), histological (presence of gastritis, ulcer, H. pylori infection, plasmacytic differentiation, Ki-67 index), and morphological (tumor size, superficial lesions or mass-forming) characteristics.


Thirty-six patients (52 %) had positive PET/CT (average SUVmax was 9±6.7; lesion-to-liver SUVmax ratio 3.7±2.6, lesion-to-blood pool SUVmax ratio 4.8±3.3) at the corresponding gastric lesion; the remaining 33 were not 18F-FDG-avid. In the univariate analysis, 18F-FDG avidity was significantly associated with morphological features (mass forming p<0.001 and high maximum diameter p<0.001), Ann Arbor stage (p=0.010), and Ki67 index (p<0.001) and not correlated with age, sex, presence of gastritis, ulcer, Helicobacter pylori infection, and plasmacytic differentiation. In the multivariate analysis, the correlations with gross morphological appearance, Ann Arbor stage, and Ki-67 score were confirmed. SUVmax, lesion-to-liver SUVmax ratio, and lesion-to-blood pool SUVmax ratio correlated significantly only with Ki67 index (p=0.047; p=0.012; p=0.042).


18F-FDG avidity was noted in 52 % of gastric MALT lymphoma and this avidity is correlated with gross morphological characteristics, tumor stage, and Ki-67 index. SUVmax, lesion-to-liver SUVmax ratio, and lesion-to-blood pool SUVmax ratio are correlated only with Ki-67 index, and only lesion-to-liver SUVmax ratio was independently associated with Ki-67 score.


Gastric MALT lymphoma Gastric lymphoma MALT lymphoma FDG avidity 18F-FDG PET/CT 


Compliance with ethical standards

Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Domenico Albano
    • 1
    • 2
    Email author
  • Mattia Bertoli
    • 1
    • 2
  • Paola Ferro
    • 2
  • Federico Fallanca
    • 3
  • Luigi Gianolli
    • 3
  • Maria Picchio
    • 3
  • Raffaele Giubbini
    • 4
  • Francesco Bertagna
    • 4
  1. 1.Nuclear Medicine, Spedali Civili BresciaBresciaItaly
  2. 2.University Milano-BicoccaMilanItaly
  3. 3.Department of Nuclear MedicineIRCCS San Raffaele Scientific InstituteMilanItaly
  4. 4.Nuclear MedicineUniversity of Brescia and Spedali Civili BresciaBresciaItaly

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