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Combined use of 18 F-FDG PET and corticosteroid for diagnosis of deep-seated primary central nervous system lymphoma without histopathological confirmation

  • Clinical Article - Brain Tumors
  • Published:
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Abstract

Background

Although histological diagnosis is indispensable in treating primary central nervous system lymphoma (PCNSL), we sometimes face an intractable situation in which tissue can be obtained only from a deep-seated brain lesion. In place of a histological diagnosis, the diagnostic adequacy of the combined use of 18 F-FDG PET and corticosteroid administration for PCNSL located in a deep-seated brain structure is reported.

Methods

Patients with a deep-seated tumor were treated as having PCNSL without histological confirmation, based on the following criteria: (1) there was no evidence of systemic malignancy; (2) the tumor showed an extremely high FDG uptake relative to normal gray matter on pretreatment 18 F-FDG PET; (3) the tumor decreased in size 1 week after diagnostic therapy by corticosteroid administration on contrast-enhanced T1-weighted magnetic resonance imaging (MRI). FDG uptake of the lesion was evaluated by the maximum of standardized uptake values (SUVmax) and tumor-to-normal ratio of the SUV (T/N ratio). The extent of the tumor reduction was calculated by volumetric analysis for the treatment response to corticosteroid administration.

Results

Ten patients (4 males and 6 females) matched these criteria. On pretreatment 18 F-FDG PET, mean SUVmax in the tumor was 24.8 (8.75–60.75), and mean T/N ratio was 3.24 (2.17–5.12). The extent of tumor volume reduction was shown to be 21 to 68 % 1 week after diagnostic therapy by corticosteroids. Mean total dose and duration of corticosteroids were 719 mg as prednisolone and 6.5 days, respectively. Nine patients achieved complete response and one patient achieved partial response on MRI after standard treatment for PCNSL with high-dose methotrexate and/or whole-brain irradiation.

Conclusion

Although the value of biopsy is universal, combining 18 F-FDG PET and corticosteroid administration is an important alternative method that may lead to the diagnosis of deep-seated PCNSLs in cases with intractable histopathological confirmations.

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, 5 West 7, Kita-ku, 060-8638, Sapporo, Japan

    Shigeru Yamaguchi, Sadahiro Kaneko, Hiroyuki Kobayashi, Shunsuke Terasaka & Kiyohiro Houkin

  2. Department of Neurosurgery, Nuclear Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Kenji Hirata, Tohru Shiga, Kentaro Kobayashi & Nagara Tamaki

  3. Department of Neurosurgery, Radiation Oncology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Rikiya Onimaru & Hiroki Shirato

Authors
  1. Shigeru Yamaguchi
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  2. Kenji Hirata
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  3. Sadahiro Kaneko
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  4. Hiroyuki Kobayashi
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  5. Tohru Shiga
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  6. Kentaro Kobayashi
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  8. Hiroki Shirato
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  9. Nagara Tamaki
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  10. Shunsuke Terasaka
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  11. Kiyohiro Houkin
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Correspondence to Shunsuke Terasaka.

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Yamaguchi, S., Hirata, K., Kaneko, S. et al. 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 (2015). https://doi.org/10.1007/s00701-014-2290-7

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  • DOI: https://doi.org/10.1007/s00701-014-2290-7

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