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Nuklearmedizin 2009; 48(05): 185-191
DOI: 10.3413/nukmed-0236
Original article
Schattauer GmbH

Integrated FDG-PET/CT for detection, therapy monitoring and follow-up of granulocytic sarcoma

Initial resultsKombinierte FDG-PET/CT zur Detektion, zum Therapie monitoring und zur Verlaufskontrolle von granulozytischen SarkomenErste Ergebnisse
P. Aschoff
1   Department of Diagnostic and Interventional Radiology, University Hospital, Eberhard-Karls-University Tuebingen
,
M. Häntschel
2   Department of Internal Medicine, University Hospital, Eberhard-Karls-University Tuebingen
,
M. Öksüz
3   Department of Nuclear Medicine, University Hospital, Eberhard-Karls-University Tuebingen, Germany
,
M. K. Werner
1   Department of Diagnostic and Interventional Radiology, University Hospital, Eberhard-Karls-University Tuebingen
,
M. Lichy
1   Department of Diagnostic and Interventional Radiology, University Hospital, Eberhard-Karls-University Tuebingen
,
W. Vogel
2   Department of Internal Medicine, University Hospital, Eberhard-Karls-University Tuebingen
,
C. Pfannenberg
1   Department of Diagnostic and Interventional Radiology, University Hospital, Eberhard-Karls-University Tuebingen
› Author Affiliations
Further Information

Publication History

received: 13 January 2009

accepted in revised form: 15 July 2009

Publication Date:
22 January 2018 (online)

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Summary

Aim: Granulocytic sarcomas (GS) are rare extramedullary manifestations of myeloid or lymphoblastic leukaemia. Laboratory examinations are of limited use for diagnosis of extramedullary disease. Radiological imaging based on morphology is challenging. To date, the possible role of FDG-PET/CT as a method for combined metabolic and morphologic imaging is unclear. We present a series of 10 patients to evaluate the potential role of FDGPET/ CT in the management of GS. Patients, materials, methods: A retrospective evaluation of 18 FDG-PET/CT exams in 10 patients with histologically proven GS was performed. All scans included a contrast enhanced CT. The FDG uptake of GS was analyzed and the sensitivity of lesion detection was compared to PET and CT alone. The changes in FDG uptake after therapy were compared to morphological changes detected by CT and follow-up / clinical outcome. Results: 52 untreated or recurrent GS lesions were detected by FDG-PET/CT and all showed an increased FDG uptake with a mean SUVmax and SUVavg of 5.1 and 3.4, respectively. GS was multifocal in 8/10 patients. Combined PET/CT avoided 5 false positive findings compared to PET alone and 13 false negative findings and 1 false positive compared to CT alone. Changes in FDG uptake after therapy correlated with clinical outcome and were more reliable than CT assessment alone. PET/CT identified recurrent GS in 3 patients. Conclusion: Viable GS are FDG-avid. Using this metabolic information and morphologic CT criteria, combined FDG-PET/CT was more accurate in lesion detection than FDG-PET or CT alone. Changes in FDG uptake after therapy might be a useful additional parameter for therapy monitoring. Therefore, FDG-PET/CT appears to be a promising diagnostic and monitoring tool in the management of patients with GS.

Zusammenfassung

Ziel: Granuloyztische Sarkome (GS) sind seltene extramedulläre Manifestationen von myelotischen oder lymphoblastischen Leukämien. Laboruntersuchungen sind zur Diagnose und zum Therapiemonitoring der extramedullären Erkrankung nur begrenzt geeignet. Die radiologisch- morphologische Beurteilung ist in ihrer Sensitivität limitiert. Die potenzielle Rolle der kombinierten metabolischen und morphologischen Bildgebung mit der FDG-PET/CT ist bisher unklar. Wir stellen eine Serie von 10 Patienten vor, um die mögliche Rolle der FDGPET/ CT im Management von GS zu evaluieren. Patienten, Methoden: Retrospektive Auswertung von 18 FDG-PET/CT-Untersuchungen inklusive diagnostischer CT bei 10 Patienten mit histologisch gesichertem GS. Analyse des FDG-Uptake und Vergleich der Sensitivität der Detektion von Läsionen mit der FDG-PET und der CT allein. Vergleich der änderung im FDGUptake nach Therapie mit morphologischen änderungen nach CT-Kriterien und dem weiteren klinischen Krankheitsverlauf. Ergebnisse: 52 unbehandelte oder rezidivierte GS wurden mittels FDG-PET/CT detektiert und zeigten einen erhöhten FDG-uptake mit einem mittleren SUVmax und SUVavg von 5,1 bzw. 3,4. GS waren bei 8/10 Patienten multifokal. Die kombinierte FDG-PET/CT vermied 5 falsch-positive Befunde im Vergleich zur FDGPET und 13 falsch-negative und einen falschpositiven Befund im Vergleich zur CT. Die änderungen im FDG-Uptake nach Therapie korrelierten mit dem klinischen Behandlungserfolg verlässlicher als die Ergebnisse der CT. Rezidive von GS konnten bei 3 Patienten mittels FDG-PET/CT detektiert werden. Schlussfolgerung: Vitale GS nehmen vermehrt FDG auf. Die Kombination dieser metabolischen Information mit CT-morphologischen Kriterien in der FDG-PET/CT verbesserte die Genauigkeit der Detektion von Läsionen im Vergleich zur FDG-PET oder CT alleine. Die änderung im FDG-Uptake nach Therapie könnte ein nützlicher zusätzlicher Parameter zur Therapiekontrolle sein. Die FDG-PET/CT scheint damit ein viel versprechendes diagnostisches Instrument beim Management von Patienten mit GS zu sein.

Keywords

FDG - PET/CT - granulocytic sarcoma - leukaemia

Schlüsselwörter

FDG - PET/CT - granulozytisches Sarkom - Leukämie
 

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