The role of positron emission tomography and combined positron emission tomography with computed tomography in staging and response assessment in patients with non-Hodgkin’s lymphoma

Authors: T. Papajík 1;  M. Mysliveček 2;  E. Buriánková 2;  M. Skopalová 3;  A. Malán 4;  V. Koza 5;  M. Trněný 6;  P. Koranda 2;  J. Ptáček 2;  K. Indrák 1
Authors‘ workplace: Hemato-onkologická klinika FNO a LF UP v Olomouci, 2Klinika nukleární medicíny FNO a LF UP v Olomouci, 3PET centrum Nemocnice na Homolce, 4Oddělení nukleární medicíny FN Plzeň, 5Hematologicko-onkologické oddělení FN Plzeň, 6I. interní klinika VFN Praha 1
Published in: Transfuze Hematol. dnes,14, 2008, No. 3, p. 110-118.
Category: Comprehensive Reports, Original Papers, Case Reports


2-[fluorin-18] fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET) is a noninvasive, 3-dimensional imaging modality sufficiently reliable for the initial diagnosis and staging, for the evaluation of therapeutic response and for the detection of recurrence of various type of non-Hodgkin’s lymphoma (NHL). 18F-FDG PET has been demonstrated more sensitive and specific than either 67scintigraphy or computed tomography (CT) and generally offers more than 88% of sensitivity and 94% of specificity in the diagnosis of NHL. However, 18F-FDG PET may not precisely anatomically localize pathological lesions in the human body. Actually, combined PET and CT – PET/CT system - has developed into the fastest growing imaging modality worldwide and the integration of PET and CT provides precise localization of the lesions on the 18F-FDG PET scans within the anatomic reference frame provided by CT, thereby increasing specificity of the examination. Some authors founded that high glycolytic rates, determined by 18FDG uptake, are associated predominantly with high-grade lymphoma, and low-grade and certain other lymphoma subtypes (e.g., peripheral T-cell NHL) have low 18F-FDG uptake that can result in negative scans. Others founded no significant difference between low-grade and high-grade NHL or B- and T-cell NHL in this respect, suggesting that the diagnostic accuracy of PET is not affected by tumor subtype or grade. In fact, a large overlap may exist between the metabolic/glycolytic activity of various lymphoma entities. On the other hand, hypermetabolic conditions (sarcoidosis, tuberculosis, fungal infections, inflammation, etc.) may be a source of “false-positive” 18F-FDG PET scans and integrated PET-CT system can help improve the specificity of the findings and our differential diagnostic accuracy in these situations.

Key words:
18F- FDG PET, PET/CT, lymphoma, staging


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