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. 2019 Dec 1;8(4):CNS46.
doi: 10.2217/cns-2019-0016. Epub 2019 Nov 29.

Utility of flouro-deoxy-glucose positron emission tomography/computed tomography in the diagnostic and staging evaluation of patients with primary CNS lymphoma

Meetakshi Gupta  1 , Tejpal Gupta  1 , Nilendu Purandare  2 , Venkatesh Rangarajan  2 , Ameya Puranik  2 , Aliasgar Moiyadi  3 , Prakash Shetty  3 , Sridhar Epari  4 , Ayushi Sahay  4 , Abhishek Mahajan  5 , Amit Janu  5 , Bhausaheb Bagal  6 , Hari Menon  6 , Sadhana Kannan  7 , Rahul Krishnatry  1 , Goda Jayant Sastri  1 , Rakesh Jalali  1
Affiliations

Utility of flouro-deoxy-glucose positron emission tomography/computed tomography in the diagnostic and staging evaluation of patients with primary CNS lymphoma

Meetakshi Gupta et al. CNS Oncol. .

Abstract

Aim: To prospectively assess the clinical utility of pretreatment flouro-deoxy-glucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in patients with primary central nervous system (CNS) lymphoma (PCNSL). Materials & methods: Patients with suspected/proven PCNSL underwent baseline whole-body 18F-FDG-PET/CT. Maximum standardized uptake value and tumor/normal tissue ratios were compared between CNS lymphoma and other histological diagnoses. Results: The mean maximum standardized uptake value (27.5 vs 18.2; p = 0.001) and mean tumor/normal tissue ratio (2.34 vs 1.53; p < 0.001) of CNS lymphoma was significantly higher than other histologic diagnoses. Five of 50 (10%) patients with biopsy-proven CNS lymphomas had pathologically increased FDG-uptake at extraneuraxial sites uncovering systemic lymphoma. Conclusion: Pretreatment whole-body 18F-FDG-PET/CT provides valuable complementary information in the diagnostic and staging evaluation of patients with PCNSL to guide therapeutic decision-making.

Keywords: FDG-PET/CT; MRI; brain; lymphoma; systemic staging.

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Conflict of interest statement

Financial & competing interests disclosure

This work was partly supported by a competitive intramural research grant from Tata Memorial Centre. All FDG-PET/CT scans on the study were funded through a competitive intramural research grant (TMC IEC Project No. 145) secured by the Principal Investigator-cum-Corresponding Author. However, the sponsor had no role in the study design, conduct, data collection, analysis or reporting of results. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Figures

Figure 1.
Figure 1.. Schematic workflow of patients through the study.
CNS: Central nervous system; FDG-PET/CT: Flouro-deoxy-glucose positron emission tomography/computed tomography; PCNSL: Primary central nervous system lymphoma.
Figure 2.
Figure 2.. Representative case examples from the study cohort.
Cranial MRI in the upper panel shows multiple, solid, periventricular lesions enhancing intensely on axial T1-weighted postcontrast image (A) and hypo-intense on axial T2-weighted image (B) with perifocal edema. Axial fused FDG-PET/CT image (C) shows significantly increased FDG-uptake with a maximum standardized uptake value (SUVmax) of 27 favoring lymphoma. Biopsy confirmed the diagnosis of PCNSL. MRI in the lower panel shows similar morphologic features on conventional neuroimaging in the form of multiple ill-defined lesions in the parietal lobe enhancing inhomogenously on axial T1-weighted postcontrast image (D) and iso-intense on axial T2-weighted image (E) with perifocal edema. In contrast to PCNSL, axial fused FDG-PET/CT image (F) shows only moderately increased FDG-uptake in the lesions with SUVmax of 12 suggestive of nonlymphomatous pathology. Diagnosis was confirmed as glioblastoma on surgical decompression. FDG: Flouro-deoxy-glucose; FDG-PET/CT: Flouro-deoxy-glucose positron emission tomography/computed tomography; MRI: Magnetic resonance imaging; PCNSL: Primary CNS lymphoma.
Figure 3.
Figure 3.. Box-plots of quantitative flouro-deoxy-glucose positron emission tomography/computed tomography parameters.
Boxplots comparing SUVmax (A) and T/N ratio (B) between central nervous system lymphoma and nonlymphomatous histology. Note significantly higher SUVmax and T/N ratio in lymphoma. SUVmax: Maximum standardized uptake value; T/N: Tumor/normal tissue.
Figure 4.
Figure 4.. Receiver operating characteristics curves of quantitative flouro-deoxy-glucose positron emission tomography/computed tomography parameters.
ROC curves of SUVmax (A) and T/N ratio (B) in the diagnosis of central nervous system lymphoma. Note that the upper left corner of the respective curves provides the most optimal cut-off of SUVmax and T/N ratio for diagnosing lymphoma. ROC: Receiver operating characteristic; SUVmax: Maximum standardized uptake value; T/N: Tumor/normal tissue.
See this image and copyright information in PMC

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