PET/CT in Non-Hodgkin Lymphoma: An Update

Zanoni, Lucia; Bezzi, Davide; Nanni, Cristina; Paccagnella, Andrea; Farina, Arianna; Broccoli, Alessandro; Casadei, Beatrice; Zinzani, Pier Luigi; Fanti, Stefano

doi:10.1053/j.semnuclmed.2022.11.001

Cited by 23 publications

(19 citation statements)

References 253 publications

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“…18 F-FDG PET/CT stands out as a noninvasive tool for discerning the metabolic activity of tumors, proving exceptionally beneficial in delineating the staging of malignant lymphoma, tracking relapse, and evaluating therapeutic response ( 40 , 41 ). When a patient is referred for evaluation of a heart lesion or an area very close to the myocardium, additional dietary recommendations can be helpful.…”

Section: Discussionmentioning

confidence: 99%

A rare case of primary cardiac diffuse large B-cell lymphoma imaged with 18F-FDG PET/CT: a case report and literature review

Huang,

Zheng,

Zhang

et al. 2024

Front. Med.

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BackgroundOne of the exceptionally rare forms of non-Hodgkin’s lymphoma (NHL) is primary cardiac lymphoma (PCL). The principal clinical manifestation in patients with PCL involves cardiac symptoms resulting from myocardial infiltration by lymphoma, including arrhythmias, heart failure, and chest pain. 18F-FDG PET/CT serves as a reliable and indispensable imaging modality for assessing clinically staging NHL.Case reportWe present a rare case involving a 72-year-old woman diagnosed with primary intracardiac diffuse large B-cell lymphoma. For further staging, the patient underwent 18F-FDG PET/CT, revealing multiple nodular soft tissue density lesions in the heart and pericardium exhibiting increased FDG metabolism (SUVmax = 12.1). The supradiaphragmatic and infradiaphragmatic segments of the inferior vena cava exhibited irregular morphology with localized nodular changes and increased FDG metabolism in the surrounding area (SUVmax = 9.7). Additionally, multiple enlarged lymph nodes were identified in the left axilla, mediastinum, and adjacent to the abdominal aorta, displaying heterogeneous FDG uptake with an SUVmax of 9.3, indicating lymphoma involvement. The above imaging findings suggested that the mass was a PCL. Hence, the patient underwent a combination of chemotherapy and immunotherapy using R-CDOP (rituximab, cyclophosphamide, liposomal doxorubicin, vincristine, and prednisone). Following two courses of treatment within a span of 2 months, there was a partial remission observed in the cardiac lymphoma and the enlarged lymph nodes.ConclusionThe case elucidated in this report contributes to an enhanced understanding of the disease for clinicians, with 18F-FDG PET/CT providing comprehensive insights into the extent of cardiac involvement, as well as the engagement of extracardiac organs and pathologic lymph nodes. The 18F-FDG PET/CT examination not only visually delineates the lesion’s location and extent but also serves as a cornerstone for clinical tumor staging, offering valuable support for treatment monitoring and subsequent follow-up.

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Section: Discussionmentioning

confidence: 99%

A rare case of primary cardiac diffuse large B-cell lymphoma imaged with 18F-FDG PET/CT: a case report and literature review

Huang,

Zheng,

Zhang

et al. 2024

Front. Med.

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“…At the same time, nuclear medicine is subject to constant change based on medical findings, innovations in equipment technology and developments of new radiopharmaceuticals with approvals of new radioactive drugs. The benefits of these diagnostic and therapeutic developments are proven by numerous methodologically high-quality studies [6,7,8,9] and is reflected in official statistics on nuclear medicine diagnostics and therapy in outpatient and inpatient care in Germany [10]. It is therefore logical to take these aspects into account when revising student teaching.…”

Section: Introductionmentioning

confidence: 99%

Update of the competence-based catalog of learning objectives in nuclear medicine for the study of human medicine in Germany

Heidemanns,

Trautmann,

Weidt

et al. 2024

Nuklearmedizin

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Aim To update the subject-specific, competence-based catalog of learning objectives for medical studies in Germany published by the German Society of Nuclear Medicine (DGN) in 2018, prioritizing relevant learning objectives. Methods Based on the previous catalog, the writing group compiled nuclear medicine topics and formulated competence-based learning objectives, including medical developments, device innovations and new radiopharmaceutical approvals. These were presented for prioritization to the 180 habilitated DGN members as an expert group in a Delphi process. The first round of voting assessed firstly the topics in terms of necessity or dispensability, and secondly the detailed learning objectives of the topics were assessed for their relevance to academic teaching in nuclear medicine. The results of the first survey were used to draft a catalog of learning objectives with final approval by the expert group in a second survey. The time available for teaching nuclear medicine was also recorded. Results The writing group developed 240 competence-based learning objectives from 41 topics. After a first Delphi round, 73 detailed competence-based learning objectives from 15 topics were compiled. The mean teaching time was 8.4 h for lectures, 3.7 h for seminars and 3.6 h for practical courses. In a second Delphi round, the agreement of the expert group was at least 95% for the selected topics and at least 90% for the detailed learning objectives. Summary The catalog of subject-specific learning objectives, updated by expert consensus, provides basic knowledge, skills and competences related to the most relevant diagnostic and therapeutic procedures in nuclear medicine, taking into account both long-established topics and recently introduced innovations.

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“…Although fluorine-18 fluorodeoxyglucose ([ 18 F]FDG) remains the leading positron emission tomography (PET) tracer for routine clinical work-up in many neoplasms and in such hematological malignancies, there is an increasing demand for more specific tracers targeting other metabolic pathways to guide early effective treatment strategies [ 3 , 4 , 5 ]. In this setting, the role of this imaging modality for the initial assessment, post-therapeutic evaluation, and prognostic value has been clearly demonstrated for both Hodgkin lymphoma (HL) and non-HL (NHL), such as diffuse large B-cell lymphoma (DLBCL) or follicular lymphoma [ 6 , 7 ]. As known, false-positive findings in [ 18 F]FDG PET/CT are frequent in specific inflammatory and infective cases such as granulomatous disease, sarcoidosis, brown adipose tissue activation, and rebound of thymic hyperplasia.…”

Section: Introductionmentioning

confidence: 99%

Emerging Role of [18F]FLT PET/CT in Lymphoid Malignancies: A Review of Clinical Results

Nappi,

Santo,

Jonghi-Lavarini

et al. 2024

Hematology Reports

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Fluorine-18 fluorodeoxyglucose ([18F]FDG) is nowadays the leading positron emission tomography (PET) tracer for routine clinical work-ups in hematological malignancies; however, it is limited by false positive findings. Notably, false positives can occur in inflammatory and infective cases or in necrotic tumors that are infiltrated by macrophages and other inflammatory cells. In this context, 3′-deoxy-3′-[18F]fluorothymidine ([18F]FLT) has been shown to be a promising imaging biomarker of hematological malignant cell proliferation. In this review, a total of 15 papers were reviewed to collect literature data regarding the clinical application of [18F]FLT PET/CT in hematological malignancies. This imaging modality seems to be a suitable tool for noninvasive assessment of tumor grading, also showing a correlation with Ki-67 immunostaining. Moreover, [18F]FLT PET/CT demonstrated high sensitivity in detecting aggressive lymphoma lesions, especially when applying a standardized uptake value (SUV) cutoff of 3. At baseline, the potential of [18F]FLT imaging as a predictive tool is demonstrated by the low tracer uptake in patients with a complete response. However, its use is limited in evaluating bone diseases due to its high physiological uptake in bone marrow. Interim [18F]FLT PET/CT (iFLT) has the potential to identify high-risk patients with greater precision than [18F]FDG PET/CT, optimizing risk-adapted therapy strategies. Moreover, [18F]FLT uptake showed a greater ability to differentiate tumor from inflammation compared to [18F]FDG, allowing the reduction of false-positive findings and making the first one a more selective tracer. Finally, FLT emerges as a superior independent predictor of PFS and OS compared to FDG and ensures a reliable early response assessment with greater accuracy and predictive value.

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PET/CT in Non-Hodgkin Lymphoma: An Update

Cited by 23 publications

References 253 publications

A rare case of primary cardiac diffuse large B-cell lymphoma imaged with 18F-FDG PET/CT: a case report and literature review

A rare case of primary cardiac diffuse large B-cell lymphoma imaged with 18F-FDG PET/CT: a case report and literature review

Update of the competence-based catalog of learning objectives in nuclear medicine for the study of human medicine in Germany

Emerging Role of [18F]FLT PET/CT in Lymphoid Malignancies: A Review of Clinical Results

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