Functional Imaging of Hodgkin’s Disease with FDG-PET and Gallium-67

Summary

We report a case of Hodgkin’s lymphoma (Stage I B) which was studied using Ga-67-scintigraphy as well as whole body FDG-PET. Ga-67-scintigraphy detected a slightly increased uptake in the paraaortic and pelvic lymph nodes. However, FDG-PET was able to localize a much larger number of affected foci with a high glucose utilization rate in the right and left paraaortal regions, in the middle of the epigastrium, in the right and left parailiacal regions and one focus in the left upper mediastinum. Our experiences give rise to the assumption that FDG-PET ist significantly superior to gallium scintigraphy in Hodgkin’s disease. Whole body FDG-PET can result in an upstaging of the patient and has therefore a major impact on the therapeutic management.

Zusammenfassung

Fallpräsentation eines Patienten mit einem M. Hodgkin (Stadium I B) der wegen V. a. Rezidiv mittels Ga-67-Szintigraphie und FDG-PET untersucht wurde. Die Ga-67-Szintigraphie zeigte eine leicht erhöhte Aufnahme im Bereich der paraaortalen und parailiakalen Lymphknoten. Mittels FDG- PET konnte eine größere Anzahl an Herden mit einer malignitätstypi- schen Anreicherungen in der Paraaortalregion, im mittleren Epigastrium, parailiakal beidseitig sowie ein Herd im linken oberen Mediastinum dargestellt werden. Unsere Erfahrungen weisen darauf hin, daß FDG-PET der Ga-67-Szintigraphie überlegen ist. FDG-PET kann zu einer Reklassifizierung der Erkrankung führen und hat somit einen großen Einfluß auf die weitere Therapie.

Keywords

Hodgkin’s lymphoma - FDG-PET - Ga-67-scintigraphy

Schlüsselwörter

M. Hodgkin - FDG-PET - Ga-67-Szintigraphie

^* PET Center Bonn, University of Bonn. Germany

• References

• 1 Newman JS, Francis IR, Kaminski MS. et al. Imaging of lymphoma with PET with 2-(F- 18)-fluoro-2-deoxy-D-glucose: Correlation with CT. Radiology 1994; 190: 111-6.
• 2 Al-Nahas AM, Hjiyiannaki P, Hammersley PAG, McCready VR, Horwich AH. Uptake of technetium-99m hexamethylpropylene amine oxime labelled white cells in lymph nodes involved in non-Hodgkin’s lyphoma. Eur J Nucl Med 1995; 22: 1453-6.
• 3 Sandrock D, Lastoria S, Magrath IT. et al. The role of gallium-67 tumour scintigraphy in patients with small, non cleaved cell lymphoma. Eur J Nucl Med 1993; 20: 119-22.
• 4 Paul R, Hoekstra OS. Comparison of Fluorine-18-2 fluorodeoxyglucose and Gallium-67 citrate imaging for detection of lymphoma. J Nucl Med 1987; 28: 288-92.
• 5 Okada J, Yoshikawa K, Imazeki K. et al. The use of FDG-PET in the detection and management of malignant lymphoma: correlation of uptake with prognosis. J Nucl Med 1991; 32: 686-91.
• 6 Ossenkoppele GJ, Golding R. et al. Early treatment response in malignant lymphoma, as determined by planar fluorine-18-fluoro- deoxyglucose scintigraphy. J Nucl Med 1993; 34: 1706-10.
• 7 Bares R, Altehoefer C, Cremerius U. et al. FDG-PET for metabolic classification of residual lymphoma masses after chemotherapy. J Nucl Med 1994; 35: 131.
• 8 Hill M, Cunningham D, Macvivar D. et al. Role of magnetic resonance imaging in predicting relapse in residual masses after treatment of lymphoma. J Clin Oncol 1993; 11 (11) 2273-8.
• 9 Rigo P, Paulus P, Kaschten BJ, Hustinx R, Bury T, Jerusalem G, Benoit T, Foidart-Willems J. Onkological applications of positron emission tomography with fluorine-18 fluorodeoxyglucose. Eur J Nucl Med 1996; 23: 1641-74.
• 10 Rodriguez M, Rehn S, Ahlström H, Sundström C, Glimelius B. Predicting malignancy grade with PET in non-Hodgkin’s lymphoma. J Nucl Med 1995; 36: 1790-6.
• 11 Okada J, Yoshikawa K, Itami M. et al. Positron emission tomography using fluorine-18-fluorodeoxyglucose in malignant lymphoma: a comparison with proliferative activity. J Nucl Med 1992; 33: 325-9.