Brain metabolic changes in Hodgkin disease patients following diagnosis and during the disease course: An 18F-FDG PET/CT study

Abstract

The aim of the present study was to investigate brain glucose metabolism in patients with Hodgkin disease (HD) after diagnosis and during chemotherapy treatment. Following the administration of first-line doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) chemotherapy, 74 HD patients underwent ¹⁸F-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) positron emission tomography (PET)/computed tomography brain scans, both baseline (PET0) and interim (PET2) at the Department of Biomedicine and Prevention, University of Rome Tor Vergata (Rome, Italy). Fifty-seven patients were further evaluated 15±6 days after four additional cycles (PET6). Furthermore, a control group (CG) of 40 chemotherapy-naïve subjects was enrolled. Differences in brain ¹⁸F-FDG uptake between the CG, PET0, PET2 and PET6 scans were analyzed using statistical parametric mapping. Compared with the PET0 and CG scans, the PET2 scan demonstrated a higher metabolic activity in Brodmann area (BA) 39, and a metabolic reduction in BA 11 bilaterally and in left BA 32. All of these changes disappeared at PET6. The results of the present study indicate that ABVD chemotherapy has a limited impact on brain metabolism.

Keywords: Hodgkin disease; adriamycin; bleomycin; chemobrain; chemotherapy; positron emission tomography; vinblastine and dacarbazine.

Figure 1

Brain 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography (PET)/computed tomography scan (A) within one week of Hodgkin disease diagnosis (PET0) and (B) 15±5 days after the first two adriamycin, bleomycin, vinblastine and dacarbazine cycles (PET2).

Figure 2

(A) Significant cortical hypometabolism in positron emission tomography (PET)2 when compared with the PET0 group. Threshold of P<0.05, corrected for multiple comparisons with false discovery rate at voxel level. (B) High 2-[18F] fluoro-2-deoxy-D-glucose uptake in the right superior parietal lobule in PET2 compared with PET0. Threshold of P<0.001, not corrected for multiple comparisons at voxel level. Coordinate and regional details are presented in Table I. PET0, brain 2-[18F] fluoro-2-deoxy-D-glucose (¹⁸F-FDG) PET/computed tomography (CT) scan within one week of Hodgkin disease diagnosis; PET2, brain ¹⁸F-FDG PET/CT scan 15±5 days after the first two adriamycin, bleomycin, vinblastine and dacarbazine cycles.