18F-FDG Hepatic Superscan in a Patient With Chronic Myeloid Leukemia

Abstract

A 62-year-old man with a history of breakpoint cluster region-ABL-positive chronic myeloid leukemia treated with hydroxyurea and interferon alfa for 4 years presented a lesion in the left lateral lobe of the liver. Besides an FDG-avid lesion, his 18F-FDG PET/CT study showed intense and diffuse FDG uptake (reminiscent of a hepatic superscan) throughout the rest of the left lobe and the right anterior lobe of the liver. This interesting superscan indicated that patients with chronic myeloid leukemia may show hepatic involvement by leukemia cells.

Detection of diffuse infiltrative primary hepatic lymphoma on FDG PET-CT: Hallmarks of hepatic superscan

“…[ 4 ] Few studies in the literature have, however, correlated the level of FDG uptake with disease activity and tumor proliferation. [ 5 ] Other differentials for hepatic superscan on FDG PET-CT include chronic myeloid leukemia,[ 6 ] tuberculosis,[ 7 ] metastases, and Richter's transformation of chronic lymphocytic leukemia. [ 8 ] In conclusion, solitary intense uptake in the liver on FDG PET-CT needs thorough evaluation and a liver biopsy should be carried out for further management.…”

Clinical pearls: Etiologies of superscan appearance on Fluorine-18-Fludeoxyglucose positron emission tomography-computed tomography

“…When interpreting skeletal scintigraphy, the term “superscan” refers to a characteristic pattern consisting of symmetrically intense and diffuse radiotracer uptake in the skeleton with absent or diminished visualization of the genitourinary system and soft tissues;[ 1 ] the term has also been employed to describe a characteristic appearance on fluorine-18-fludeoxyglucose positron emission tomography-computed tomography (18-F-FDG PET/CT) imaging. [ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 ]…”

“…By analogy, superscan patterns have also been described in 18-F-FDG PET/CT scanning. [ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 ] This usage of the term “superscan” implies sequestration of radiopharmaceutical in an organ or organ system with loss or reduction in the amount of activity detected in those organs normally associated with significant physiologic uptake of 18-F-FDG such as the kidneys, brain, or myocardium. As in skeletal scintigraphy, “superscan” has been used to refer to those 18-F-FDG PET/CT scans in which diffuse and intense activity throughout the skeleton is accompanied by reduced visualization of the usual physiologic activity, especially that of the kidneys [ Figure 2 ].…”

“…The term has also been employed, however, to describe 18-F-FDG PET/CT scans in which liver uptake is extremely high with reduction of the normal physiologic background activity (the “hepatic superscan”) [ Figure 3 ]. [ 2 4 5 9 11 12 13 ]…”

18F-FDG hepatic superscan caused by a non-germinal center subtype of diffuse large B-cell lymphoma

“…Conventional imaging techniques (CT, MR and ultrasound) usually fail to identify the abnormality. 18 F-FDG PET is valuable in detecting diffuse hepatic diseases [2,3].…”