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Radiopraxis 2022; 15(03): E68-E85
DOI: 10.1055/a-1860-6125
CPD-Fortbildung

[18F]FDG-PET/CT bei Lymphomen – Pitfalls und Normvarianten

Gregor Schweighofer-Zwink
,
Julia Pilz
,
Mohsen Beheshti
,
Christian Pirich
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Nuklearmediziner*innen sollten mit Normvarianten in der Bildgebung und häufigen Pitfalls, die zu Fehlinterpretationen und damit zu potenziellen Änderungen des Managements bei Patienten mit Hodgkin und Non-Hodgkin-Lymphomen führen könnten, vertraut sein. In diesem Artikel geben wir einen Überblick über häufig auftretende Pitfalls in der [18F]FDG PET/CT bei Lymphomen sowie über seltene Ursachen für Fehlbefunde und deren Interpretation.

Schlüsselwörter

Lymphom - [18F]FDG - PET/CT - Pitfalls - onkologische Diagnostik


Publication History

Article published online:
27 September 2022

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  • Literatur

  • 1 Barrington SF, OʼDoherty MJ. Limitations of PET for imaging lymphoma. Eur J Nucl Med Mol Imaging 2003; 30: S117-S127
    CrossrefPubMedGoogle Scholar
  • 2 Pauwels EK, Ribeiro MJ, Stoot JH. et al. FDG accumulation and tumor biology. Nucl Med Biol 1998; 25: 317-322
    CrossrefPubMedGoogle Scholar
  • 3 Barrington SF, Mikhaeel NG, Kostakoglu L. et al. Role of imaging in the staging and response assessment of lymphoma: consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol 2014; 32: 3048-3058
    CrossrefPubMedGoogle Scholar
  • 4 Cheson BD, Fisher RI, Barrington SF. et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol 2014; 32: 3059-3068
    CrossrefPubMedGoogle Scholar
  • 5 Kubota R, Yamada S, Kubota K. et al. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med 1992; 33: 1972-1980
    PubMedGoogle Scholar
  • 6 Parysow O, Mollerach AM, Jager V. et al. Low-dose oral propranolol could reduce brown adipose tissue F-18 FDG uptake in patients undergoing PET scans. Clin Nucl Med 2007; 32: 351-357
    CrossrefPubMedGoogle Scholar
  • 7 Hutchings M, Barrington SF. PET/CT for therapy response assessment in lymphoma. J Nucl Med 2009; 50: 21s-30s
    CrossrefPubMedGoogle Scholar
  • 8 Barrington SF, Qian W, Somer EJ. et al. Concordance between four European centres of PET reporting criteria designed for use in multicentre trials in Hodgkin lymphoma. Eur J Nucl Med Mol Imaging 2010; 37: 1824-1833
    CrossrefPubMedGoogle Scholar
  • 9 Hoang-Xuan K, Bessell E, Bromberg J. et al. Diagnosis and treatment of primary CNS lymphoma in immunocompetent patients: guidelines from the European Association for Neuro-Oncology. Lancet Oncol 2015; 16: e322-e332
    CrossrefPubMedGoogle Scholar
  • 10 Hojgaard L, Berthelsen AK, Loft A. Head and neck: normal variations and benign findings in FDG positron emission tomography/computed tomography imaging. PET Clin 2014; 9: 141-145
    CrossrefPubMedGoogle Scholar
  • 11 Nakamoto Y, Tatsumi M, Hammoud D. et al. Normal FDG distribution patterns in the head and neck: PET/CT evaluation. Radiology 2005; 234: 879-885
    CrossrefPubMedGoogle Scholar
  • 12 Bertagna F, Treglia G, Piccardo A. et al. Diagnostic and clinical significance of F-18-FDG-PET/CT thyroid incidentalomas. The Journal of clinical endocrinology and metabolism 2012; 97: 3866-3875
    CrossrefPubMedGoogle Scholar
  • 13 Seo YL, Yoon DY, Baek S. et al. Incidental focal FDG uptake in the parotid glands on PET/CT in patients with head and neck malignancy. Eur Radiol 2015; 25: 171-177
    CrossrefPubMedGoogle Scholar
  • 14 Ferdinand B, Gupta P, Kramer EL. Spectrum of thymic uptake at 18F-FDG PET. Radiographics 2004; 24: 1611-1616
    CrossrefPubMedGoogle Scholar
  • 15 Wachsmann JW, Gerbaudo VH. Thorax: normal and benign pathologic patterns in FDG-PET/CT imaging. PET Clin 2014; 9: 147-168
    CrossrefPubMedGoogle Scholar
  • 16 Alavi A, Gupta N, Alberini JL. et al. Positron emission tomography imaging in nonmalignant thoracic disorders. Semin Nucl Med 2002; 32: 293-321
    CrossrefPubMedGoogle Scholar
  • 17 Heron CW, Husband JE, Williams MP. Hodgkin disease: CT of the thymus. Radiology 1988; 167: 647-651
    CrossrefPubMedGoogle Scholar
  • 18 Leibundgut K, Willi U, Pluss HJ. Thymic rebound following successful chemotherapy of B-lymphoma in an adolescent boy. Eur J Pediatr 1992; 151: 95-97
    CrossrefPubMedGoogle Scholar
  • 19 Michigishi T, Mizukami Y, Shuke N. et al. Visualization of the thymus with therapeutic doses of radioiodine in patients with thyroid cancer. Eur J Nucl Med 1993; 20: 75-79
    CrossrefPubMedGoogle Scholar
  • 20 Brink I, Reinhardt MJ, Hoegerle S. et al. Increased metabolic activity in the thymus gland studied with 18F-FDG PET: age dependency and frequency after chemotherapy. J Nucl Med 2001; 42: 591-595
    PubMedGoogle Scholar
  • 21 Caffey J, Silbey R. Regrowth and overgrowth of the thymus after atrophy induced by the oral administration of adrenocorticosteroids to human infants. Pediatrics 1960; 26: 762-770
    CrossrefPubMedGoogle Scholar
  • 22 Paidisetty S, Blodgett TM. Brown fat: atypical locations and appearances encountered in PET/CT. AJR Am J Roentgenol 2009; 193: 359-366
    CrossrefPubMedGoogle Scholar
  • 23 Karam M, Roberts-Klein S, Shet N. et al. Bilateral hilar foci on 18F-FDG PET scan in patients without lung cancer: variables associated with benign and malignant etiology. J Nucl Med 2008; 49: 1429-1436
    CrossrefPubMedGoogle Scholar
  • 24 Ungprasert P, Carmona EM, Utz JP. et al. Epidemiology of Sarcoidosis 1946-2013: A Population-Based Study. Mayo Clin Proc 2016; 91: 183-188
    CrossrefPubMedGoogle Scholar
  • 25 Dubreuil J, Salles G, Bozzetto J. et al. Usual and unusual pitfalls of 18F-FDG-PET/CT in lymphoma after treatment: a pictorial review. Nucl Med Commun 2017; 38: 563-576
    CrossrefPubMedGoogle Scholar
  • 26 Takahashi H, Yamashita H, Morooka M. et al. The utility of FDG-PET/CT and other imaging techniques in the evaluation of IgG4-related disease. Joint Bone Spine 2014; 81: 331-336
    CrossrefPubMedGoogle Scholar
  • 27 Groves AM, Win T, Screaton NJ. et al. Idiopathic pulmonary fibrosis and diffuse parenchymal lung disease: implications from initial experience with 18F-FDG PET/CT. J Nucl Med 2009; 50: 538-545
    CrossrefPubMedGoogle Scholar
  • 28 Deandreis D, Leboulleux S, Dromain C. et al. Role of FDG PET/CT and chest CT in the follow-up of lung lesions treated with radiofrequency ablation. Radiology 2011; 258: 270-276
    CrossrefPubMedGoogle Scholar
  • 29 Zukotynski K, Kim CK. Abdomen: normal variations and benign conditions resulting in uptake on FDG-PET/CT. PET Clin 2014; 9: 169-183
    CrossrefPubMedGoogle Scholar
  • 30 Mahmud MH, Nordin AJ, Ahmad Saad FF. et al. Impacts of biological and procedural factors on semiquantification uptake value of liver in fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging. Quantitative imaging in medicine and surgery 2015; 5: 700-707
    PubMedGoogle Scholar
  • 31 Ghimire P, Wu GY, Zhu L. Primary gastrointestinal lymphoma. World J Gastroenterol 2011; 17: 697-707
    CrossrefPubMedGoogle Scholar
  • 32 Herrmann R, Panahon AM, Barcos MP. et al. Gastrointestinal involvement in non-Hodgkinʼs lymphoma. Cancer 1980; 46: 215-222
    Google Scholar
  • 33 Gontier E, Fourme E, Wartski M. et al. High and typical 18FFDG bowel uptake in patients treated with metformin. Eur J Nucl Med Mol Imaging 2008; 35: 95-99
    CrossrefPubMedGoogle Scholar
  • 34 Boland GW, Lee MJ, Gazelle GS. et al. Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR Am J Roentgenol 1998; 171: 201-204
    CrossrefPubMedGoogle Scholar
  • 35 de Jong PA, van Ufford HM, Baarslag HJ. et al. CT and 18FFDG PET for noninvasive detection of splenic involvement in patients with malignant lymphoma. AJR Am J Roentgenol 2009; 192: 745-753
    CrossrefPubMedGoogle Scholar
  • 36 Pilkington P, Lopci E, Adam JA. et al. FDG-PET/CT Variants and Pitfalls in Haematological Malignancies. Semin Nucl Med 2021; 51: 554-571
    CrossrefPubMedGoogle Scholar
  • 37 Khademi S, Westphalen AC, Webb EM. et al. Frequency and etiology of solitary hot spots in the pelvis at whole-body positron emission tomography/computed tomography imaging. Clin Imaging 2009; 33: 44-48
    CrossrefPubMedGoogle Scholar
  • 38 Kohan A, Avril NE. Pelvis: normal variants and benign findings in FDG-PET/CT imaging. PET Clin 2014; 9: 185-193
    CrossrefPubMedGoogle Scholar
  • 39 Lin KH, Chen YS, Hu G. et al. Chronic bacterial prostatitis detected by FDG PET/CT in a patient presented with fever of unknown origin. Clin Nucl Med 2010; 35: 894-895
    Google Scholar
  • 40 Metser U, Even-Sapir E. Increased (18)F-fluorodeoxyglucose uptake in benign, nonphysiologic lesions found on wholebody positron emission tomography/computed tomography (PET/CT): accumulated data from four years of experience with PET/CT. Semin Nucl Med 2007; 37: 206-222
    CrossrefPubMedGoogle Scholar
  • 41 Dammacco F, Rubini G, Ferrari C. et al. (1) (8)F-FDG PET/CT: a review of diagnostic and prognostic features in multiple myeloma and related disorders. Clin Exp Med 2015; 15: 1-18
    CrossrefPubMedGoogle Scholar
  • 42 Choi YY, Kim JY, Yang SO. PET/CT in benign and malignant musculoskeletal tumors and tumor-like conditions. Semin Musculoskelet Radiol 2014; 18: 133-148
    Article in Thieme ConnectPubMedGoogle Scholar
  • 43 Błaż M, Palczewski P, Swiątkowski J. et al. Cortical fibrous defects and non-ossifying fibromas in children and young adults: The analysis of radiological features in 28 cases and a review of literature. Polish journal of radiology 2011; 76: 32-39
    PubMedGoogle Scholar
  • 44 Pagano M, Berta M, Postini AM. et al. Nonossifying fibroma: A possible pitfall in F18-FD-PET/CT imaging of Hodgkinʼs disease. Radiol Case Rep 2011; 6: 271
    CrossrefPubMedGoogle Scholar
  • 45 Rahman WT, Wale DJ, Viglianti BL. et al. The impact of infection and inflammation in oncologic (18)F-FDG PET/CT imaging. Biomedicine & pharmacotherapy=Biomedecine & pharmacotherapie 2019; 117: 109168
    CrossrefPubMedGoogle Scholar
  • 46 Thomas DL, Syrbu S, Graham MM. Epstein-Barr virus mimicking lymphoma on FDG-PET/CT. Clin Nucl Med 2009; 34: 891-893
    CrossrefPubMedGoogle Scholar
  • 47 Pan Q, Luo Y, Wu H. et al. Epstein-Barr Virus-Associated Hemophagocytic Lymphohistiocytosis Mimicking Lymphoma on FDG PET/CT. Clin Nucl Med 2018; 43: 125-127
    CrossrefPubMedGoogle Scholar
  • 48 Ørbӕk M, Graff J, Markova E. et al. (18)F-FDG PET/CT Findings in Acute Epstein-Barr Virus Infection Mimicking Malignant Lymphoma. Diagnostics (Basel, Switzerland) 2016; 6: 18
    PubMedGoogle Scholar
  • 49 Lustberg MB, Aras O, Meisenberg BR. FDG PET/CT findings in acute adult mononucleosis mimicking malignant lymphoma. European journal of haematology 2008; 81: 154-156
    CrossrefPubMedGoogle Scholar
  • 50 Makis W, Hickeson M, Blumenkrantz M. Interesting image. Dermatopathic lymphadenitis: a pitfall for lymphoma evaluation by F-18 FDG PET/CT. Clin Nucl Med 2010; 35: 872-874
    CrossrefPubMedGoogle Scholar
  • 51 Graveleau J, Grossi O, Lefebvre M. et al. Vertebral osteomyelitis: an unusual presentation of Bartonella henselae infection. Seminars in arthritis and rheumatism 2011; 41: 511-516
    CrossrefPubMedGoogle Scholar
  • 52 Makis W, Ciarallo A, Gonzalez-Verdecia M. et al. Systemic Lupus Erythematosus Associated Pitfalls on (18)F-FDG PET/CT: Reactive Follicular Hyperplasia, Kikuchi-Fujimoto Disease, Inflammation and Lymphoid Hyperplasia of the Spleen Mimicking Lymphoma. Nucl Med Mol Imag 2018; 52: 74-79
    CrossrefPubMedGoogle Scholar
  • 53 Geerdes-Fenge HF, Löbermann M, Warnke P. et al. Mediastinal Lymphadenopathy – Tuberculosis or Tularemia?. Dtsch Med Wochenschr (1946) 2019; 144: 1276-1279
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 Martinet P, Khatchatourian L, Saidani N. et al. Hypermetabolic pulmonary lesions on FDG-PET/CT: Tularemia or neoplasia?. Infect Dis Now 2021; 51: 607-613
    CrossrefPubMedGoogle Scholar
  • 55 Mortensen BK, Nielsen SD, Christensen CB. et al. Immune reconstitution syndrome presenting as probable AIDSrelated lymphoma: a case report. AIDS Res Ther 2011; 8: 34
    CrossrefPubMedGoogle Scholar
  • 56 Sohn S, Shi HJ, Wang SH. et al. Mycobacterium avium complex infection-related immune reconstitution inflammatory syndrome mimicking lymphoma in an human immunodeficiency virus-infected patient. Infect Chemother 2018; 50: 350-356
    CrossrefPubMedGoogle Scholar
  • 57 Schwerz S, Mueller M, Lindemann-Docter K. et al. Hepatic candidiasis mimicking lymphoma on 18F-FDG PET/CT in a patient with T cell lymphoma. Eur J Nuclear Med Mol Imag 2020; 47: 2925-2926
    CrossrefPubMedGoogle Scholar
  • 58 Egeler RM, Neglia JP, Aricò M. et al. Acute leukemia in association with Langerhans cell histiocytosis. Med Pediat Oncol 1994; 23: 81-85
    CrossrefPubMedGoogle Scholar
  • 59 Ben-Haim S, Ell P. 18F-FDG PET and PET/CT in the evaluation of cancer treatment response. J Nucl Med 2009; 50: 88-99
    CrossrefPubMedGoogle Scholar
  • 60 Nilak YD, Nilak A, Shafeek S. et al. Benign histiocyte-rich pseudotumor in post treatment mediastinal Hodgkinʼs lymphoma. Radiology case reports 2020; 15: 156-160
    CrossrefPubMedGoogle Scholar
  • 61 Mainolfi CG, DʼAntonio A, Mango G. et al. Ileal inflammatory pseudotumor in adolescent male patient with prior Burkitt lymphoma: A challenging diagnosis. Radiol Case Rep 2021; 16: 2047-2052
    CrossrefPubMedGoogle Scholar
  • 62 Hod N, Lantsberg S, Anconina R. et al. Postchemotherapy Histiocyte-Rich Pseudotumor of the Spleen Simulating Residual Disease in a Patient With Non-Hodgkin Lymphoma on FDG PET/CT. Clin Nucl Med 2019; 44: e409-e412
    CrossrefPubMedGoogle Scholar
  • 63 Kashyap R, Lau E, George A. et al. High FDG activity in focal fat necrosis: a pitfall in interpretation of posttreatment PET/CT in patients with non-Hodgkin lymphoma. European journal of nuclear medicine and molecular imaging 2013; 40: 1330-1336
    CrossrefPubMedGoogle Scholar
  • 64 Belakhlef A, Jani C, Church C. et al. Fat necrosis mimicking B-cell lymphoma: a PET/CT and FDG study. Clin Nucl Med 2008; 33: 271-272
    CrossrefPubMedGoogle Scholar
  • 65 Kapoor H, Hatfield W, El Khouli R. et al. Iatrogenic Cushingʼs syndrome on (18)F-FDG-PET/CT: A pitfall in metabolic assessment of oncologic response. Clin Imag 2021; 75: 27-29
    CrossrefPubMedGoogle Scholar
  • 66 Hofman MS, Hicks RJ. White fat, factitious hyperglycemia, and the role of FDG PET to enhance understanding of adipocyte metabolism. EJNMMI research 2011; 1: 2
    CrossrefPubMedGoogle Scholar
  • 67 Kong MC, Nadel HR. 18F-FDG PET/CT With Diffusely High FDG Uptake Throughout Subcutaneous Adipose Tissues. Clin Nucl Med 2018; 43: 762-763
    CrossrefPubMedGoogle Scholar
  • 68 O JH, Lodge MA, Wahl RL. Practical PERCIST: A Simplified Guide to PET Response Criteria in Solid Tumors 1.0. Radiology 2016; 280: 576-584
  • 69 Bleeker-Rovers CP, van der Ven AJ, Zomer B. et al. F-18-fluorodeoxyglucose positron emission tomography for visualization of lipodystrophy in HIV-infected patients. AIDS 2004; 18: 2430-2432
    PubMedGoogle Scholar
  • 70 Niu N, Zhu ZH, Ma YR. et al. Features of Acquired Immunodeficiency Syndrome-related Lymphoma on (18)F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography. Zhongguo yi xue ke xue yuan xue bao Acta Academiae Medicinae Sinicae 2015; 37: 602-606
    PubMedGoogle Scholar
  • 71 Caton MT, Miskin N, Hyun H. 18F-FDG Uptake in subcutaneous fat preceding clinical diagnosis of human immunodeficiency virus-associated lipodystrophy. Clin Nucl Med 2018; 43: e475-e476
    CrossrefPubMedGoogle Scholar
  • 72 Thomassen A, Lerberg Nielsen A, Gerke O. et al. Duration of 18F-FDG avidity in lymph nodes after pandemic H1N1v and seasonal influenza vaccination. Eur J Nucl Med Mol Imaging 2011; 38: 894-898
    CrossrefPubMedGoogle Scholar
  • 73 Shin M, Hyun CY, Choi YH. et al. COVID-19 Vaccination-Associated Lymphadenopathy on FDG PET/CT: Distinctive Features in Adenovirus-Vectored Vaccine. Clin Nucl Med 2021; 46: 814-819
    CrossrefPubMedGoogle Scholar
  • 74 Mingos M, Howard S, Giacalone N. et al. Systemic Immune Response to Vaccination on FDG-PET/CT. Nucl Med Mol Imag 2016; 50: 358-361
    CrossrefPubMedGoogle Scholar
  • 75 Ayati N, Jesudason S, Berlangieri SU. et al. Generalized Lymph Node Activation after Influenza Vaccination on (18)F FDG-PET/CT Imaging, an Important Pitfall in PET Interpretation. Asia Ocean J Nucl Med Biol 2017; 5: 148-150
    PubMedGoogle Scholar
  • 76 Bacanovic S, Stiller R, Pircher M. et al. Ovarian Hyperstimulation and Oocyte Harvesting Prior to Systemic Chemotherapy-A Possible Pitfall in 18F-FDG PET/CT Staging of Oncologic Patients. Clin Nucl Med 2016; 41: e394-e396
    CrossrefPubMedGoogle Scholar
  • 77 Cunningham JR, OʼMalley JP. et al. Ovarian hyperstimulation and breast cancer on PET imaging with sonographic correlation. Clin Nucl Med 2015; 40: 430-432
    CrossrefPubMedGoogle Scholar
  • 78 Subhas N, Patel PV, Pannu HK. et al. Imaging of pelvic malignancies with in-line FDG PET-CT: case examples and common pitfalls of FDG PET. Radiographics 2005; 25: 1031-1043
    CrossrefPubMedGoogle Scholar