Brain and whole-body FDG-PET in diagnosis, treatment monitoring and long-term follow-up of primary CNS lymphoma

Sofiane Maza 1 , Ralph Buchert 2 , Winfried Brenner 2 , Dieter Ludwig Munz 2 , Eckhard Thiel 3 , Agnieszka Korfel 3 , and Philipp Kiewe 3
  • 1 Department of Nuclear Medicine, Vivantes MVZ Spandau, Berlin, Germany
  • 2 Department of Nuclear Medicine
  • 3 Department of Hematology, Charité-Universitätsmedizin, Berlin, Germany

Background. Positron emission tomography (PET) with F-18-labeled fluorodeoxyglucose (FDG) provides remarkable accuracy in detection, treatment monitoring and follow-up of systemic malignant lymphoma. Its value in the management of patients with primary central nervous system lymphoma (PCNSL) is less clear.

Patients and methods. In a prospective trial, 42 FDG-PET examinations were performed in ten immunocompetent patients with newly diagnosed or recurrent PCNSL before and repeatedly during and after the treatment. Brain and whole body FDG-PET were compared to brain MRI and extra-cerebral CT, respectively.

Results. Before the treatment, 6 of 10 patients had congruent findings on FDG-PET and MRI of the brain. Three patients had lesions on brain MRI, not detected by FDG-PET. One patient had additional FDG-PET positive lesions inconspicuous in MRI. The follow-up suggested FDG-PET to be false positive in these lesions. After the treatment, brain PET was in agreement with MRI in 6 of 8 patients. In the remaining 2 patients there were persistent lesions in brain MRI whereas FDG-uptake was reduced to normal values. In the long-term follow-up of 5 patients (63-169 weeks), 3 patients retained normal in both PET and MRI. In 2 patients a new focal pathologic FDG-uptake was detected 69 and 52 weeks after the end of the treatment. In one of these patients, recurrence was confirmed by MRI not until 9 weeks after PET.

Conclusions. Brain FDG-PET may contribute valuable information for the management of PCNSL, particularly in the assessment of the treatment response. Integration of FDG-PET into prospective interventional trials is warranted to investigate prognostic and therapeutic implications.

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  • 1. Kimura N, Yamamoto Y, Kameyama R, Hatakeyama T, Kawai N, Nishiyama Y. Diagnostic value of kinetic analysis using dynamic 18F-FDG-PET in patients with malignant primary brain tumor. Nucl Med Commun 2009; 30: 602-9.

  • 2. Heald AE, Hoffman JM, Bartlett JA, Waskin HA. Differentiation of central nervous system lesions in AIDS patients using positron emission tomography (PET). Int J STD AIDS 1996; 7: 337-46.

  • 3. Pierce MA, Johnson MD, Maciunas RJ, Murray MJ, Allen GS, Harbison MA, et al. Evaluating contrast-enhancing brain lesions in patients with AIDS by using positron emission tomography. Ann Intern Med 1995; 123: 594-8.

  • 4. Di Chiro G. Positron emission tomography using [18F] fluorodeoxyglucose in brain tumors. A powerful diagnostic and prognostic tool. Invest Radiol 1987; 22: 360-71.

  • 5. Kuwabara Y, Ichiya Y, Otsuka M, Miyake Y, Gunasekera R, Hasuo K, et al. High [18F]FDG uptake in primary cerebral lymphoma: a PET study. J ComputAssist Tomogr 1988;12: 47-8.

  • 6. Mohile NA, Deangelis LM, Abrey LE. The utility of body FDG PET in staging primary central nervous system lymphoma. Neuro Oncol 2008; 10: 223-8.

  • 7. Mohile NA, Deangelis LM, Abrey LE. Utility of brain FDG-PET in primary CNS lymphoma. Clin Adv Hematol Oncol 2008; 6: 818-20, 840.

  • 8. Kawai N, Okubo S, Miyake K, Maeda Y, Yamamoto Y, Nishiyama Y, et al. Use of PET in the diagnosis of primary CNS lymphoma in patients with atypical MR findings. Ann Nucl Med 2010; 24: 335-43.

  • 9. Palmedo H, Urbach H, Bender H, Schlegel U, Schmidt-Wolf IG, Matthies A, et al. FDG-PET in immunocompetent patients with primary central nervous system lymphoma: correlation with MRI and clinical follow-up. Eur J NuclMed Mol Imaging 2006; 33: 164-8.

  • 10. Rosenfeld SS, Hoffman JM, Coleman RE, Glantz MJ, Hanson MW, Schold SC. Studies of primary central nervous system lymphoma with fluorine-18-fluorodeoxyglucose positron emission tomography. J Nucl Med 1992; 33: 532-6.

  • 11. Karantanis D, O’Eill B P, Subramaniam RM, Witte RJ, Mullan BP, Nathan MA, et al. 18F-FDG PET/CT in primary central nervous system lymphoma in HIVnegative patients. Nucl Med Commun 2007; 28: 834-41.

  • 12. Karantanis D, O’Neill BP, Subramaniam RM, Peller PJ, Witte RJ, Mullan BP, et al. Contribution of F-18 FDG PET-CT in the detection of systemic spread of primary central nervous system lymphoma. Clin Nucl Med 2007; 32: 271-4.

  • 13. 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 Imaging 2007; 34: 78-86.

  • 14. Abrey LE, Batchelor TT, Ferreri AJ, Gospodarowicz M, Pulczynski EJ, Zucca E, et al. Report of an international workshop to standardize baseline evaluation and response criteria for primary CNS lymphoma. J Clin Oncol 2005; 23: 5034-43.

  • 15. Kiewe P, Fischer L, Martus P, Thiel E, Korfel A. Primary central nervous system lymphoma: monocenter, long-term, intent-to-treat analysis. Cancer 2008; 112: 1812-20.

  • 16. Korfel A, Martus P, Nowrousian MR, Hossfeld DK, Kirchen H, Brucher J, et al. Response to chemotherapy and treating institution predict survival in primary central nervous system lymphoma. Br J Haematol 2005; 128: 177-83.


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