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

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.

Abstract

Malignant lymphoma is a quite common malignancy affecting all age groups. The usefulness of positron emission tomography/computed tomography using 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG PET/CT) has already been widely established in the assessment of Hodgkin lymphoma and many forms of non-Hodgkin lymphoma. However, many factors such as histopathological characteristics and previous and ongoing therapies may affect the [18F]FDG uptake in various organs. Furthermore, nuclear medicine physicians should be familiar with imaging variants and atypical findings as well as common pitfalls, which may cause misinterpretation and might lead to inappropriate management of the disease. In this article we review common pitfalls and variants of [18F]FDG PET/CT imaging in lymphoma and present cases with atypical findings with recommendations on accurate interpretation.

Kernaussagen

• Die [¹⁸F]FDG PET/CT ist ein Standardverfahren für die Bildgebung beim Morbus Hodgkin, diffus großzelligen B-Zell-Lymphom (DLCBCL) und beim follikulären Lymphom.

• Semiquantitative Parameter wie der SUV_max und das Speicherungsmuster unterstützen bei der Differenzierung zwischen physiologischer (z. B. im braunen Fettgewebe oder im Ovar), entzündlicher (z. B. in der Schilddrüse) und maligner Gewebespeicherung.

• Entzündliche Autoimmunerkrankungen (systemischer Lupus erythematodes) und granulomatöse Erkrankungen wie die Sarkoidose oder Tuberkulose können differenzialdiagnostische Herausforderungen darstellen.

• In der Interims- oder posttherapeutischen [¹⁸F]FDG PET/CT-Bildgebung nach 6 Monaten ist die Thymushyperplasie oder der Thymus-Rebound ein relativ häufiger benigner Befund.

• Insulin und Metformin steigern die Aufnahme von [¹⁸F]FDG im Gastrointestinaltrakt und führen zu einem typischen Speicherungsmuster. Der (iatrogene) Hyperkortisolismus ist mit einer erhöhten subkutanen Speicherung in hyperplastischem, weißem Fettgewebe verbunden, während die Anreicherung im lymphatischen Gewebe abnimmt.

• Mit der Verfügbarkeit und Anwendung der (saisonal eingesetzten) Impfungen wird gehäuft das Vorliegen falsch-positiver Mehrspeicherungen in meist axillären, subpektoralen oder mediastinalen Lymphknoten nach Influenza- oder COVID-19 Vazkinierung beobachtet. Da diese Veränderungen bis zu 40 Tage nach Vakzinierung nachweisbar sind, ist die Anamnese mit Hinweis auf die Applikationsseite sehr hilfreich.

Schlüsselwörter

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

Keywords

lymphoma - [¹⁸F]FDG, PET/CT - pitfalls - oncological diagnostics

Publication History

Article published online:
07 March 2022

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