Potential role of (18)F-2-fluoro-2-deoxy-glucose positron emission tomography/computed tomography imaging in patients presenting with generalized lymphadenopathy

Abstract

Generalized lymphadenopathy is a common and often vexing clinical problem caused by various inflammatory, infective and malignant diseases. We aimed to review briefly and highlight the potential role of (18)F-2-fluoro-2-deoxy-glucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) in such patients. (18)F-FDG PET/CT can play an important role in the management of generalized lymphadenopathy. It can help in making an etiological diagnosis; can detect extranodal sites of involvement and employed for monitoring response to therapy.

Keywords: 18F-2-fluoro-2-deoxy-glucose positron emission tomography/computed tomography; generalized lymphadenopathy; lymphoma; sarcoidosis; tuberculosis.

Figure 1

(a-c) A 58-year-old female with histologically confirmed Rosai Dorfman disease. Maximum intensity projection positron emission tomography (PET) image (a) and trans-axial PET/computed tomography images of neck (b), and abdomen (c), revealed multiple enlarged ¹⁸F-2-fluoro-2-deoxy-glucose avid bilateral cervical, axillary, retroperitoneal and mesenteric lymph nodes (arrows) along with splenic lesion (broken arrow)

Figure 2

(a-c) An 18-year-old male with Castleman's disease. Maximum intensity projection positron emission tomography (PET) image (a) revealed multiple enlarged ¹⁸F-2-fluoro-2-deoxy-glucose avid cervical, axillary, mediastinal, retroperitoneal and inguinal lymph nodes (arrows). Transaxial PET/computed tomography images demonstrating splenic (b, arrowhead) and bone marrow (c, broken arrow) involvement

Figure 3

(a-c) A 31-year-old female with sarcoidosis, for baseline evaluation. Maximum intensity projection positron emission tomography (PET) image (a) revealed multiple enlarged ¹⁸F-2-fluoro-2-deoxy-glucose (¹⁸F-FDG) avid cervical, axillary, mediastinal, portal, retroperitoneal and inguinal lymph nodes (broken arrows). Note is made of the “lambda sign” due to typical symmetrical ¹⁸F-FDG avid mediastinal lymph nodes involvement (a, bold arrows) transaxial PET/computed tomography images demonstrating lung (b, arrows) and splenic (c, arrows) involvement

Figure 4

(a-c) A 21-year-old female, known case of tuberculosis. Maximum intensity projection positron emission tomography (PET) image (a) revealed multiple enlarged ¹⁸F-2-fluoro-2-deoxy-glucose (¹⁸F-FDG) avid cervical, axillary, mediastinal, mesenteric, retroperitoneal and inguinal lymph nodes (arrows) transaxial PET/computed tomography (CT) images of thorax (b) ¹⁸F-FDG avid nodal (arrow) involvement. Note the calcification in mediastinal nodes (broken arrow). Transaxial PET/CT image of the lungs (c) ¹⁸F-FDG avid pulmonary involvement

Figure 5

(a-d) A 27-year-old male who presented with generalized lymphadenopathy. Transaxial positron emission tomography/computed tomography images (a-d) revealed mildly ¹⁸F-2-fluoro-2-deoxy-glucose avid bilateral cervical, axillary, mediastinal and abdominal lymph nodes (arrows). Biopsy from the lymph node was positive for actinomycosis

Figure 6

(a-f) A 38-year-old male with Hodgkin lymphoma (a and b), revealing ¹⁸F-2-fluoro-2-deoxy-glucose (¹⁸F-FDG) avid cervical, mediastinal, abdominal and inguinal lymph nodes, (a) apart from splenic (b, arrow) and liver (b, broken arrow) involvement. 34-year-old female with DLBCL (c and d), revealing ¹⁸F-FDG avid enlarged cervical, axillary, mediastinal, abdominal and inguinal lymph nodes, apart from splenic (c, broken arrow) and bone marrow (d, arrow) involvement. 73-year-old female with B-cell SLL (e and f), revealing mildly ¹⁸F-FDG-avid generalized lymph node involvement (arrows) with loss of normal architecture (f, arrows)

Figure 7

(a and b) A 57-year-old male with CD3+ peripheral T-cell lymphoma. Maximum intensity projection (MIP) positron emission tomography (PET) image (a) revealing ¹⁸F-2-fluoro-2-deoxy-glucose (¹⁸F-FDG) avid bilateral multiple cervical, axillary, mediastinal, abdomino-pelvic and inguinal lymph nodes (broken arrows), 27-year-old male with angiolymphoblastic T-cell lymphoma. MIP PET image (b) revealing mild to moderately ¹⁸F-FDG avid bilateral multiple cervical, axillary, mediastinal, abdomino-pelvic and inguinal lymph nodes (arrows)

Figure 8

(a-c) A 67-year-old female with biopsy proven ovarian carcinoma. Maximum intensity projection positron emission tomography (PET) image (a) and transaxial PET/computed tomography images (b and c) revealed multiple enlarged ¹⁸F-2-fluoro-2-deoxy-glucose avid cervical, axillary, mediastinal, retroperitoneal, mesenteric and pelvic metastatic lymph nodes (arrows)