(18)F-FDG PET/CT in Neurolymphomatosis: Report of 3 Cases

Abstract

Neurolymphomatosis is a rare manifestation of non-Hodgkin lymphoma characterized by infiltration of peripheral nerves, nerve roots, plexus and cranial nerves by malignant lymphocytes. This report presents positron emission tomography/computed tomography (PET/CT)imaging with 2-deoxy-2-(18)F-fluoro-D-glucose ((18)F-FDG) in 3 cases of non-Hodgkin lymphoma with nerve infiltration, including one newly diagnosed lymphoma, one recurrent lymphoma in previous nerve lesions and one newly recurrent lymphoma. PET/CT could reveal the affected neural structures including cranial nerves, spinal nerve roots, brachial plexus, cervicothoracic ganglion, intercostal nerves, branches of the vagus nerve, lumbosacral plexus and sciatic nerves. There was relative concordance between PET/CT and MRI in detection of affected cranial nerves. PET/CT seemed to be better than MRI in detection of affected peripheral nerves. (18)F-FDG PET/CT was a whole-body imaging technique with the ability to reveal the affected cranial nerves, peripheral nerves, nerve roots and plexus in non-Hodgkin lymphoma. A thorough understanding of disease and use of advanced imaging modalities will increasingly detect neurolymphomatosis.

Keywords: 18F-FDG; Nerve; Neurolymphomatosis; PET/CT; Plexus.

Figure 1

Axial contrast-enhanced T1W MRI showed enlargement and enhancement of the left cranial nerves: (A) complex of cranial nerves III, IV, VI, V1, V2 (long arrow); (A, B) cranial nerves V (short arrows); (C) cranial nerve V3 (long arrow) and complex of cranial nerves VII/VIII (short arrow); and (D) complex of cranial nerves IX, X, XI

Figure 2

Coronal fat-suppressed, contrast-enhanced T1W MRI showed enlargement and enhancement of the left C7, C8 nerve roots and brachial plexus

Figure 3

Maximum intensity projection of brain coronal (A) and sagital (B), and PET/CT images of brain (C-I) showed increased FDG uptake in the left cranial nerves: (A-E) Cranial nerves V and V3; (B, G) complex of cranial nerves III, IV, VI, V1, V2 at cavernous sinus (long arrows); (H) complex of cranial nerves IX, X, XI at jugular foramen; and (I) cranial nerve XII at hypoglossal canal

Figure 4

Maximum intensity projection of whole body (A) and PET/CT images (B-H) showed increased FDG uptake in the left C2 nerve root (B); C5-C6 spinal cord, C7 nerve root, brachial plexus (C,D); multiple focal lesions in liver (E); and bilateral lumbosacral plexuses and along the sciatic nerves (G,H)

Figure 5

Maximum intensity projection of whole body (A) and PET/CT images (B) showed increased FDG uptake in the right C6, C7, C8, T1nerve roots and branchial plexus, and bilateral T2, T3 nerve roots

Figure 6

Axial contrast-enhanced T1W MRI (A, B) and CT image (C) showed enlargement and enhancement ofbilateral cranial nerve V and Gasser’s ganglions. Complex of the right cranial nerve VII/VIII was seen only on T1W image (B)

Figure 7

Maximum intensity projection of brain tranaxial (A) coronal (B) and sagital (C); PET/CT (D, G) and PET images (E) showed increased FDG uptake in bilateral cranial nerve V, Gasser’s ganglions, and complex of the right cranial nerve VII/VIII

Figure 8

Maximum intensity projection of whole body coronal (A), sagital (B), thoracic transaxial (C), and PET/CT images (D, E) showed increased FDG uptake of the right cervicothoracic ganglion (long arrow), along the 7^th-10^th intercostal nerves, branches of the vagus nerve (blue arrows)