Abstract
Objective
The diagnosis of primary central nervous system lymphoma (PCNSL) in immunocompetent patients with atypical magnetic resonance (MR) findings such as disseminated lesions or no (non-enhancing) lesion is sometimes difficult because of mimicking other tumorous and non-tumorous diseases. Positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) and 11C-methionine (MET) can measure the glucose and amino acid metabolism in the lesions and may provide useful information for diagnosing PCNSL in patients with such subtle MR findings.
Methods
We performed PET studies with FDG and MET in 17 histologically proven PCNSL and compared the uptake of FDG and MET qualitatively and quantitatively in the tumors between 12 typical and 5 atypical MR findings.
Results
All typical PCNSL showed strong uptake of FDG and MET; however, visual analysis of FDG and MET uptake in atypical PCNSL was not very useful for finding lesions in the brain. Semiquantitative FDG and MET uptake values (SUVmax) and quantitative FDG influx rate constant (K i ) in the tumors are significantly lower in atypical PCNSL compared with those in typical PCNSL. These values obtained in the lesions with atypical MR findings were also not useful for differentiating PCNSL from other tumorous and non-tumorous diseases. The k 3 values evaluated by FDG kinetic analysis in atypical PCNSL were similar to those obtained in typical PCNSL.
Conclusions
Visual analysis of FDG and MET uptake in atypical PCNSL was not useful for finding the lesions in the brain. Semiquantitative and quantitative values obtained in the lesions with atypical MR findings were also not useful for differentiating PCNSL from other tumorous and non-tumorous diseases. The k 3 values evaluated by FDG kinetic analysis in atypical PCNSL may provide valuable information in the diagnosis of PCNSL.
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Abbreviations
- PET:
-
Positron emission tomography
- CNS:
-
Central nervous system
- MR:
-
Magnetic resonance
References
Kawai N, Nishiyama Y, Miyake K, Tamiya T, Nagao S. 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. 2005;19:685–90.
Palmedo H, Urbach H, Bender H, Schlegel U, Schmidt-Wolf IGH, Matthies A, et al. FDG-PET in immunocompetent patients with primary central nervous system lymphoma: correlation with MRI and clinical follow-up. Eur J Nucl Med Mol Imag. 2006;33:164–8.
Nishiyama Y, Yamamoto Y, Monden T, Sasakawa Y, Kawai N, Satoh K, et al. Diagnostic value of kinetic analysis using dynamic FDG PET in immunocompetent patients with primary CNS lymphoma. Eur J Nucl Med Mol Imag. 2007;34:78–86.
Ogawa T, Kanno I, Hatazawa J, Inugami A, Fijita H, Shimosegawa E, et al. Methionine PET for follow-up of radiation therapy of primary lymphoma of the brain. Radiographics. 1994;14:101–10.
Erdag N, Bhorade RM, Alberico RA, Yousuf N, Patel MR. Primary lymphoma of the central nervous system: typical and atypical CT and MR imaging appearances. Am J Roentgenol. 2001;176:1319–26.
Haldorsen IS, Kråkenes J, Krossnes BK, Mella O, Espeland A. CT and MRI imaging features of primary central nervous system lymphoma in Norway, 1989–2003. Am J Neuroradiol. 2009;30:744–51.
Fine HA, Mayer RJ. Primary central nervous system lymphoma. Ann Intern Med. 1993;119:1093–104.
Herholz K, Hölzer T, Bauer B, Schröder R, Voges J, Ernestus R-I, et al. 11C-methionine PET for differential diagnosis of low-grade gliomas. Neurology. 1998;50:1316–22.
Phelps ME, Huang SC, Hoffman EJ, Selin C, Sokoloff L, Kuhl DE. Tomographic measurement of local cerebral glucose metabolic rate in humans with (F-18) 2-fluoro-2-deoxy-d-glucose: validation of method. Ann Neurol. 1979;6:371–88.
Corn BW, Marcus SM, Tophan A, Hauck W, Curran WJ Jr. Will primary central nervous system lymphoma be the most frequent brain tumor diagnosed in 2000? Cancer. 1997;79:2409–13.
Behin A, Hoang-Xuan K, Caroentier AF, Delattre J-Y. Primary brain tumours in adults. Lancet. 2003;361:323–31.
DeAngelis LM, Seiferheld W, Schold SC, Fischer B, Schultz CJ. Combination chemotherapy and radiotherapy for primary central nervous system lymphoma: Radiation Therapy Oncology Group Study 93-10. J Clin Oncol. 2002;20:4643–8.
Küker W, Nägele T, Korfel A, Heckl S, Thiel E, Bamberg M, et al. Primary central nervous system lymphoma (PCNSL): MRI features at presentation in 100 patients. J Neurooncol. 2005;72:169–77.
Hoffman JM, Waskin HA, Schifter T, Hanson MW, Gray L, Rosenfeld S, et al. FDG-PET in differentiating lymphoma from nonmalignant central nervous system lesions in patients with AIDS. J Nucl Med. 1993;34:567–75.
Plowman PN, Saunders CA, Maisey MN. Gliomatosis cerebri: disconnection of the cortical grey matter, demonstrated on PET scan. Br J Neurosurg. 1998;12:240–4.
Dethy S, Goldman S, Blecic S, Luxen A, Levivier M, Hildebrand J. Carbon-11-methionine and fluorine-18-FDG PET study in brain hematoma. J Nucl Med. 1994;35:1162–6.
Jacob A. Amino acid uptake in ischemically compromised brain tissue. Stroke. 1995;26:1859–66.
Tsuyaguchi N, Sunada I, Ohata K, Takami T, Nishio A, Hara M, et al. Evaluation of treatment effects in brain abscess with positron emission tomography: comparison of fluorine-18-fluorodeoxyglucose and carbon-11-methionine. Ann Nucl Med. 2003;17:47–51.
Padma MV, Adineh M, Pugar K, Mukherjee J, Satter M, Shi B, et al. Functional imaging of a large demyelinating lesion. J Clin Neurosci. 2005;12:176–8.
Herholz K, Rudolf J, Heiss WD. FDG transport and phosphorylation in human gliomas measured with dynamic PET. J Neurooncol. 1992;12:159–65.
Kawai N, Kawanishi M, Tamiya T, Nagao S. Usefulness of [18F]FDG-PET kinetic analysis in non-enhancing primary central nervous system lymphoma: case report. Ann Nucl Med. 2005;19:415–9.
Kawai N, Miyake K, Nishiyama Y, Yamamoto Y, Sasakawa Y, Haba R, et al. FDG-PET findings of the brain in lymphomatoid granulomatosis. Ann Nucl Med. 2006;20:683–7.
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The authors appreciate the excellent technical support of the radiological technologist at our institution.
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Kawai, N., Okubo, S., Miyake, K. et al. Use of PET in the diagnosis of primary CNS lymphoma in patients with atypical MR findings. Ann Nucl Med 24, 335–343 (2010). https://doi.org/10.1007/s12149-010-0356-z
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DOI: https://doi.org/10.1007/s12149-010-0356-z