Skip to main content

Advertisement

SpringerLink
Log in

18F-FDG PET/CT in primary brain lymphoma

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

The actual role of 18F-FDG PET/CT in evaluating primary brain lymphoma is still an open issue. Brain lymphoma usually show elevated 18F-FDG uptake, often higher than other brain tumors or inflammatory processes, but the metabolic behavior of this lymphoma is not still understood. Our aim was to investigate the particular metabolic behavior of this lymphoma. Forty six patients (21 female, 25 male) with histologically-confirmed brain lymphoma who underwent 18F-FDG PET/CT from vertex to the mid-thigh for initial staging were retrospectively evaluated. The PET images were analyzed visually and semi-quantitatively by measuring the maximum standardized uptake value (SUVmax), lesion-to-liver SUVmax ratio, lesion-to-blood pool SUVmax ratio and the tumor to normal brain uptake ratio (T/N ratio) and compared with epidemiological (age, sex, HIV infection) and morphological (tumor size, MRI appearance) characteristics. Thirty-eight patients (83%) had positive 18F-FDG PET/CT (average SUVmax was 15.6 ± 9.2; lesion-to-liver SUVmax ratio 5.8 ± 2.8; lesion-to-blood pool SUVmax ratio 7.1 ± 3.8, T/N ratio 3.1 ± 1.7) at the corresponding brain lesion; the remaining 8 (17%) were not 18F-FDG avid. 18F-FDG avidity was significantly associated with morphological appearance and tumor size and not correlated with other features. 18F-FDG PET/CT detected extracranial disease in two cases (4%) with negative bone marrow biopsies and CT. In conclusion, brain lymphomas are 18F-FDG avid in 83% of cases showing high 18F-FDG uptake and 18F-FDG avidity is correlated with tumor size and morphological appearance of the lesion. PET/CT helped to recognize extracranial disease in two patients.

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

Similar content being viewed by others

References

  1. Miller DC, Hochberg FH, Harris NL, Gruber ML, Louis DN, Cohen H (1994) Pathology with clinical correlation of primary central nervous system non-Hodgkin’s lymphoma. Cancer 74:1383–1397

    Article  CAS  PubMed  Google Scholar 

  2. Behin A, Hoang-Xuan K, Carpentier AF, Delattre JY (2003) Primary brain tumours in adults. Lancet 361:323–331

    Article  PubMed  Google Scholar 

  3. Ricard D, Idbaih A, Ducray F, Lahutte M, Hoang-Xuan K, Delattre JY (2012) Primary brain tumours in adults. Lancet 379:1984–1996

    Article  PubMed  Google Scholar 

  4. Hochberg FH, Miller DC (1988) Primary central nervous system lymphoma. J Neurosurg 68:835–853

    Article  CAS  PubMed  Google Scholar 

  5. van der Sanden GA, Schouten LJ, van Dijck JA, van Andel JP, van der Maazen RW, Coebergh JW (2002) Primary central nervous system lymphomas: incidence and survival in the Southern and Eastern Netherlands. Cancer 94:1548–1556

    Article  PubMed  Google Scholar 

  6. Olson JE, Janney CA, Rao RD, Cerhan JR, Kurtin PJ, Schiff D et al (2002) The continuing increase in the incidence of primary central nervous system non-Hodgkin lymphoma: a surveillance, epidemiology, and end results analysis. Cancer 95:1504–1510

    Article  PubMed  Google Scholar 

  7. Kadan-Lottick NS, Skluzacek MC, Gurney JG (2002) Decreasing incidence rates of primary central nervous system lymphoma. Cancer 95:193–202

    Article  PubMed  Google Scholar 

  8. Bataille B, Delwail V, Menet E, Vandermarcq P, Ingrand P, Wager M et al (2000) Primary intracerebral malignant lymphoma: report of 248 cases. J Neurosurg 92:261–266

    Article  CAS  PubMed  Google Scholar 

  9. Kuker W, Nagele T, Korfel A, Heckl S, Thiel E, Bamberg M et al (2005) Primary central nervous system lymphomas (PCNSL): MRI features at presentation in 100 patients. J Neurooncol 72:169–177

    Article  PubMed  Google Scholar 

  10. Haldorsen IS, Krakenes J, Krossnes BK, Mella O, Espeland A (2009) CT and MR imaging features of primary central nervous system lymphoma in Norway, 1989–2003. AJNR Am J Neuroradiol 30:744–751

    Article  CAS  PubMed  Google Scholar 

  11. Jack CR Jr, O’Neill BP, Banks PM, Reese DF (1988) Central nervous system lymphoma: histologic types and CT appearance. Radiology 167:211e5

    Article  Google Scholar 

  12. Kosaka N, Tsuchida T, Uematsu H, Kimura H, Okazawa H, Itoh H (2008) 18F-FDG PET of common enhancing malignant brain tumors. AJR Am J Roentgenol 190:W365–W369

    Article  PubMed  Google Scholar 

  13. Makino K, Hirai T, Nakamura H, Murakami R, Kitajima M, Shigematsu Y et al (2011) Does adding FDG-PET to MRI improve the differentiation between primary cerebral lymphoma and glioblastoma? Observer performance study. Ann Nucl Med 25:432–438

    Article  PubMed  Google Scholar 

  14. Palmedo H, Urbach H, Bender H, Schlegel U, Schmidt-Wolf GH, Matthies A et al (2006) FDG-PET in immunocompetent patients with primary central nervous system lymphoma: correlation with MRI and clinical follow-up. Eur J Nucl Med Mol Imaging 33:164–168

    Article  CAS  PubMed  Google Scholar 

  15. Kawai N, Miyake K, Yamamaoto Y, Nishiyama Y, Yamiya T (2013) 18F-FDG PET in the diagnosis and treatment of primary central nervous system lymphoma. Biomed Res Int 2013:247152

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kawai N, Nishiyama Y, Miyake K, Tamiya T, Nagao S (2005) Evaluation of tumor FDG transport and metabolism in primary central nervous system lymphoma using [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) kinetic analysis. Ann Nucl Med 19:685–690

    Article  PubMed  Google Scholar 

  17. Nishiyama Y, Yamamoto Y, Monden T, Sasakawa Y, Kawai N, Satoh K et al (2007) Diagnostic value of kinetic analysis using dynamic FDG PET in immunocompetent patients with primary CNS lymphoma. Eur J Nucl Med Mol Imaging 34:78–86

    Article  PubMed  Google Scholar 

  18. Kawase Y, Yamamoto Y, Kameyama R, Kawai N, Kudomi N, Nishiyama Y (2011) Comparison of 11C-methionine PET and 18F-FDG PET in patients with primary central nervous system lymphoma. Mol Imaging Biol 13:1284–1289

    Article  PubMed  Google Scholar 

  19. Soret M, Bacharach SL, Buvat I (2007) Partial-volume effect in PET tumor imaging. J Nucl Med 48(6):932–945

    Article  PubMed  Google Scholar 

  20. Hoffman JM, Waskin HA, Schifter T, Hanson MW, Gray L, Rosenfeld S et al (1993) FDG-PET in differentiating lymphoma from nonmalignant central nervous system lesions in patients with AIDS. J Nucl Med 34:567–575

    CAS  PubMed  Google Scholar 

  21. Heald AE, Hoffman JM, Bartlett JA, Waskin HA (1996) Differentiation of central nervous system lesions in AIDS patients using positron emission tomography (PET). Int J STD AIDS 7:337–346

    Article  CAS  PubMed  Google Scholar 

  22. Pierce MA, Johnson MD, Maciunas RJ, Murray MJ, Allen GS, Harbison MA et al (1995) Evaluating contrast-enhancing brain lesions in patients with AIDS by using positron emission tomography. Ann Intern Med 123:594–598

    Article  CAS  PubMed  Google Scholar 

  23. Villringer K, Jager H, Dichgans M, Ziegler S, Poppinger J, Herz M et al (1995) Differential diagnosis of CNS lesions in AIDS patients by FDG-PET. J Comput Assist Tomogr 19:532–536

    Article  CAS  PubMed  Google Scholar 

  24. Rosenfeld SS, Hoffman JM, Coleman RE, Glantz MJ, Hanson MW, Schold SC (1992) Studies of primary central nervous system lymphoma with fluorine-18-fluorodeoxyglucose positron emission tomography. J Nucl Med 33:532–536

    CAS  PubMed  Google Scholar 

  25. Meric K, Killeen RP, Abi-Ghanem AS, Soliman F, Novruzov F, Cakan E et al (2015) The use of 18F-FDG PET ratios in the differential diagnosis of common malignant brain tumors. Clin Imaging 39:970–974

    Article  PubMed  Google Scholar 

  26. Purandare NC, Puranik A, Shah S, Agrawal A, Gupta T, Moiyadi A et al (2017) Common malignant brain tumors: can 18F-FDG PET/CT aid in differentiation? Nucl Med Commun. https://doi.org/10.1097/MNM.0000000000000753

    PubMed  Google Scholar 

  27. Yang M, Sun J, Bai HX, Tao Y, Tang X, States LJ et al (2017) Diagnostic accuracy of SPECT, PET, and MRS for primary central nervous system lymphoma in HIV patients: a systematic review and meta-analysis. Medicine 96:e6676

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kawai N, Zhen HN, Miyake K, Yamamaoto Y, Nishiyama Y, Tamiya T (2010) Prognostic value of pretreatment 18F-FDG PET in patients with primary central nervous system lymphoma:SUV-based assessment. J Neurooncol 100:225–232

    Article  PubMed  Google Scholar 

  29. Karantanis D, O’Eill BP, Subramaniam RM, Witte RJ, Mullan BP, Nathan MA et al (2007) 18F-FDG PET/CT in primary central nervous system lymphoma in HIV-negative patients. Nucl Med Commun 28:834–841

    Article  PubMed  Google Scholar 

  30. Yamaguchi S, Hirata K, Kobayashi H, Shiga T, Manabe O, Kobayashi K et al (2014) The diagnostic role of (18)F-FDG PET for primary central nervous system lymphoma. Ann Nucl Med 28:603–609

    Article  CAS  PubMed  Google Scholar 

  31. Yamaguchi S, Hirata K, Kaneko S, Kobayashi H, Shiga T, Kobayashi K et al (2015) Combined use of 18 F-FDG PET and corticosteroid for diagnosis of deep-seated primary central nervous system lymphoma without histopathological confirmation. Acta Neurochir 157:187–194

    Article  PubMed  Google Scholar 

  32. Maza S, Buchert R, Brenner W, Munz DL, Thiel E, Korfel A et al (2013) Brain and whole-body FDG PET in diagnosis, treatment monitoring and long-term follow-up of primary CNS lymphoma. Radiol Oncol 47:103–110

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kasenda B, Haug V, Schorb E, Fritsch K, Finke J, Mix M et al (2013) 18F-FDG PET is an independent outcome predictor in primary central nervous system lymphoma. J Nucl Med 54:184–191

    Article  CAS  PubMed  Google Scholar 

  34. Mohile NA, Deangelis LM, Abrey LE (2008) Utility of brain FDGPET in primary CNS lymphoma. Clin Adv Hematol Oncol 6(818–820):840

    Google Scholar 

  35. Mohile NA, Deangelis LM, Abrey LE (2008) The utility of body FDG PET in staging primary central nervous system lymphoma. Neuro Oncol 10:223–228

    Article  PubMed  PubMed Central  Google Scholar 

  36. Jo JC, Yoon DH, Kim S, Lee K, Kang EH, Park JS et al (2017) Interim 18F-FGD PET/CT may not predict the outcome in primary central nervous system lymphoma patients treated with sequential treatment with methotrexate and cytarabine. Ann Hematol 96:1509–1515

    Article  CAS  PubMed  Google Scholar 

  37. Kawai N, Okubo S, Miyake K, Maeda Y, Yamamoto Y, Nishiyama Y et al (2010) Use of PET in the diagnosis of primary CNS lymphoma in patients with atypical MR findings. Ann Nucl Med 24:335–343

    Article  PubMed  Google Scholar 

  38. Hustinx R, Smith RJ, Benard F, Bhatnagar A, Alavi A (1999) Can the standardized uptake value characterize primary brain tumors on FDG-PET? Eur J Nucl Med 26:1501–1509

    Article  CAS  PubMed  Google Scholar 

  39. Albano D, Bertoli M, Ferro P, Fallanca F, Gianolli L, Picchio M et al (2017) 18F-FDG PET/CT in gastric MALT lymphoma: a bicentric experience. Eur J Nucl Med Mol Imaging 44:589–597

    Article  CAS  PubMed  Google Scholar 

  40. Bertagna F, Piccardo A, Dib B, Bertoli M, Fracassi F, Bosio G et al (2015) Multicentre study of 18F-FDG-PET/CT prostate incidental uptake. Jpn J Radiol 33:538–546

    Article  CAS  PubMed  Google Scholar 

  41. Albano D, Bosio G, Giubbini R, Bertagna F (2017) 18F-FDG PET/CT and extragastric MALT lymphoma: role of Ki-67 score and plasmacytic differentiation. Leuk lymphoma. https://doi.org/10.1080/10428194.2017.1298754

    Google Scholar 

  42. O’Neill BP, Dinapoli RP, Kurtin PJ, Habermann TM. Occult systemic non-Hodgkin’s lymphoma (NHL) in patients initially diagnosed as primary central nervous system lymphoma (PCNSL): how much staging is enough?. J Neurooncol 1995;25:67–71

    Article  PubMed  Google Scholar 

  43. Karantanis D, O’Neill BP, Subramaniam RM, Peller PJ, Witte RJ, Mullan BP et al (2007) Contribution of F-18 FDG PET-CT in the detection of systemic spread of primary central nervous system lymphoma. Clin Nucl Med 32:271–271

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nuclear Medicine, Spedali Civili Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy

    Domenico Albano, Giovanni Bosio & Mattia Bertoli

  2. Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy

    Raffaele Giubbini & Francesco Bertagna

Authors
  1. Domenico Albano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni Bosio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mattia Bertoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raffaele Giubbini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francesco Bertagna
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Domenico Albano.

Ethics declarations

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 participant included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Albano, D., Bosio, G., Bertoli, M. et al. 18F-FDG PET/CT in primary brain lymphoma. J Neurooncol 136, 577–583 (2018). https://doi.org/10.1007/s11060-017-2686-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-017-2686-3

Keywords

Search

Navigation