Is There a Role for [18F]FDG PET-CT in Staging MALT Lymphoma?

Abstract

The role of 18F-fluorodeoxyglucose ([18F]FDG) positron emission tomography—computed tomography (PET-CT) in assessing mucosa-associated lymphoid tissue (MALT) lymphoma is debatable. We retrospectively explored the role of [18F]FDG PET-CT in staging and predicting progression-free-survival (PFS) of patients with newly-diagnosed MALT lymphoma. Sixty-six studies were included. The maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were documented in the “hottest” extranodal and nodal lesions. Extranodal lesions and accompanying nodal disease were detected on PET in 38/66 (57.6%) and 13/66 (19.7%) studies, respectively. Detection rate of extranodal lesions differed significantly between those located in tissues with high/heterogeneous (e.g., stomach) vs low/homogenous (e.g., subcutaneous-tissue, lung) physiologic [18F]FDG-uptake (40.4% vs. 100%, p < 0.01). Nodal lesions had significantly lower SUVmax, MTV and TLG compared with extrandodal lesions in the same patients. Detection and [18F]FDG-avidity of extranodal lesions were higher in patients with advanced, bulky disease and concomitant marrow/nodal involvement. Increased SUVmax of extranodal lesions predicted shorter PFS (HR 1.10, 95% CI 1.01–1.19, p = 0.02). Higher SUVmax and TLG showed trends towards shorter PFS in patients with localized disease. In conclusion, detection rate of extranodal MALT lymphoma lesions located in tissues with low/homogeneous physiologic [18F]FDG-uptake is excellent on [18F]FDG PET-CT. When detected, SUVmax of extranodal lesions may predict PFS.

Management of Extranodal Marginal Zone Lymphoma: Present and Upcoming Perspectives

“…FDG-uptake such as subcutaneous tissue and lungs. In addition, it shows good detection rates for salivary glands and thyroid manifestations [ 70 ]. However, its use in gastric EMZL remains investigational since physiological and/or inflammatory 18F-FDG-activity in the stomach can mask malignant lesions [ 69 , 71 ].…”

Soft Tissue Mucosa-Associated Lymphoid Tissue Lymphoma: A Rare Case With an Interesting Presentation and Review of the Literature

“…FDG-PET/CT imaging has achieved an unprecedented reputation in the field of lymphoma. The extent of MALT lymphoma on FDG-PET/CT poses two challenges: low FDG-avidity of extranodal lesions MALT lymphoma and their tendency to be located in tissues with physiologic FDG-uptake, making interpretation difficult [8].…”

Renal mucosa-associated lymphoid tissue lymphoma: a case report and literature review

“…(5,13) Radiographic presentations may vary, as well as their clinical presentation. (14) There are no differences in terms of imaging diagnosis since it debuts as a renal mass. The role of PET-FDG (18F-fluorodeoxyglucose positron emission tomography computed tomography) in this scenario remains debatable due to the low avidity of MALT lymphoma extranodal lesions, and their tendency to be located in tissues with physiologic [18F]FDG-uptake can make image interpretation difficult.…”