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High FDG activity in focal fat necrosis: a pitfall in interpretation of posttreatment PET/CT in patients with non-Hodgkin lymphoma

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

PET/CT has a major role in lymphoma imaging, but glycolytic activity in inflammatory processes can reduce specificity. In this study we evaluated restaging PET/CT findings in patients with non-Hodgkin lymphoma (NHL) and fat necrosis.

Methods

We identified 16 patients from 8,819 restaging FDG PET/CT scans with suspicion of or biopsy-proven fat necrosis on PET/CT.

Results

All patients had NHL and demonstrated focal FDG-avid nodular change on CT with density higher than that of fat but lower than that of soft tissue. Histological confirmation was obtained in eight patients, with high GLUT-1 staining between necrotic tissue and organizing fat necrosis evident. Uptake resolved in four patients, and surveillance was continuing in four without relapse.

Conclusion

Although rare, identification of fat necrosis in patients with a solitary FDG-avid nodule after therapy is important and may lead to the avoidance of unnecessary interventions or treatment. Specific features on CT aid identification, whilst follow-up imaging can be helpful as the metabolic abnormality regresses with time.

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References

  1. Baba S, Abe K, Isoda T, Maruoka Y, Sasaki M, Honda H. Impact of FDG-PET/CT in the management of lymphoma. Ann Nucl Med. 2011;25:701–16. doi:10.1007/s12149-011-0549-0.

    Article  PubMed  Google Scholar 

  2. MacManus MP, Seymour JF, Hicks RJ. Overview of early response assessment in lymphoma with FDG-PET. Cancer Imaging. 2007;7:10–8. doi:10.1102/1470-7330.2007.0004.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hicks RJ, Mac Manus MP, Seymour JF. Initial staging of lymphoma with positron emission tomography and computed tomography. Semin Nucl Med. 2005;35:165–75. doi:10.1053/j.semnuclmed.2005.02.003.

    Article  PubMed  Google Scholar 

  4. Hofman MS, Smeeton NC, Rankin SC, Nunan T, O’Doherty MJ. Observer variation in interpreting 18F-FDG PET/CT findings for lymphoma staging. J Nucl Med. 2009;50:1594–7. doi:10.2967/jnumed.109.064121.

    Article  PubMed  Google Scholar 

  5. McDermott S, Skehan SJ. Whole body imaging in the abdominal cancer patient: pitfalls of PET-CT. Abdom Imaging. 2010;35:55–69. doi:10.1007/s00261-008-9493-4.

    Article  PubMed  Google Scholar 

  6. De Gaetano AM, Calcagni ML, Rufini V, Valentini AL, Gui B, Giordano A, et al. Imaging of gynecologic malignancies with FDG PET-CT: case examples, physiologic activity, and pitfalls. Abdom Imaging. 2009;34:696–711. doi:10.1007/s00261-008-9457-8.

    Article  PubMed  Google Scholar 

  7. Kapoor V, Fukui MB, McCook BM. Role of 18FFDG PET/CT in the treatment of head and neck cancers: posttherapy evaluation and pitfalls. AJR Am J Roentgenol. 2005;184:589–97.

    Article  PubMed  Google Scholar 

  8. Guy SD, Tramontana AR, Worth LJ, Lau E, Hicks RJ, Seymour JF, et al. Use of FDG PET/CT for investigation of febrile neutropenia: evaluation in high-risk cancer patients. Eur J Nucl Med Mol Imaging. 2012;39:1348–55. doi:10.1007/s00259-012-2143-7.

    Article  PubMed  Google Scholar 

  9. Hollinger EF, Alibazoglu H, Ali A, Green A, Lamonica G. Hematopoietic cytokine-mediated FDG uptake simulates the appearance of diffuse metastatic disease on whole-body PET imaging. Clin Nucl Med. 1998;23:93–8.

    Article  PubMed  CAS  Google Scholar 

  10. Ng AP, Wirth A, Seymour JF, Lee M, Hogg A, Januszewicz H, et al. Early therapeutic response assessment by (18)FDG-positron emission tomography during chemotherapy in patients with diffuse large B-cell lymphoma: isolated residual positivity involving bone is not usually a predictor of subsequent treatment failure. Leuk Lymphoma. 2007;48:596–600. doi:10.1080/10428190601099965.

    Article  PubMed  Google Scholar 

  11. Meignan M, Gallamini A, Itti E, Barrington S, Haioun C, Polliack A. Report on the Third International Workshop on Interim Positron Emission Tomography in Lymphoma held in Menton, France, 26-27 September 2011 and Menton 2011 consensus. Leuk Lymphoma. 2012;53:1876–81. doi:10.3109/10428194.2012.677535.

    Article  PubMed  Google Scholar 

  12. Adejolu M, Huo L, Rohren E, Santiago L, Yang WT. False-positive lesions mimicking breast cancer on FDG PET and PET/CT. AJR Am J Roentgenol. 2012;198:W304–14. doi:10.2214/AJR.11.7130.

    Article  PubMed  Google Scholar 

  13. Belakhlef A, Jani C, Church C, Fraser R, Lakhanpal S. Fat necrosis mimicking B-cell lymphoma: a PET/CT and FDG study. Clin Nucl Med. 2008;33:271–2. doi:10.1097/RLU.0b013e3181662bbf.

    Article  PubMed  Google Scholar 

  14. Singh AK, Gervais DA, Lee P, Westra S, Hahn PF, Novelline RA, et al. Omental infarct: CT imaging features. Abdom Imaging. 2006;31:549–54. doi:10.1007/s00261-005-0251-6.

    Article  PubMed  CAS  Google Scholar 

  15. Daskalogiannaki M, Voloudaki A, Prassopoulos P, Magkanas E, Stefanaki K, Apostolaki E, et al. CT evaluation of mesenteric panniculitis: prevalence and associated diseases. AJR Am J Roentgenol. 2000;174:427–31.

    Article  PubMed  CAS  Google Scholar 

  16. Horton KM, Lawler LP, Fishman EK. CT findings in sclerosing mesenteritis (panniculitis): spectrum of disease. Radiographics. 2003;23:1561–7. doi:10.1148/rg.1103035010.

    Article  PubMed  Google Scholar 

  17. Canyigit M, Koksal A, Akgoz A, Kara T, Sarisahin M, Akhan O. Multidetector-row computed tomography findings of sclerosing mesenteritis with associated diseases and its prevalence. Jpn J Radiol. 2011;29:495–502. doi:10.1007/s11604-011-0587-5.

    Article  PubMed  Google Scholar 

  18. Zissin R, Metser U, Hain D, Even-Sapir E. Mesenteric panniculitis in oncologic patients: PET-CT findings. Br J Radiol. 2006;79:37–43. doi:10.1259/bjr/29320216.

    Article  PubMed  CAS  Google Scholar 

  19. Joerger M, Nuessli DF, Henz S, Zaunbauer W, Cerny T, Cogliatti SB, et al. CT-diagnosed mesenteric alterations in patients with non-Hodgkin’s lymphoma: a population-based study. Onkologie. 2008;31:514–9. doi:10.1159/000151624.

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank Dr. M. Dickinson, Professor M. Prince and Associate Professor D. Ritchie for contributing cases. Dr. R. Kashyap was supported by Endeavour Awards, a venture of Austraining International in partnership with the Government of Australia.

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Correspondence to Michael S. Hofman.

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Kashyap, R., Lau, E., George, A. et al. High FDG activity in focal fat necrosis: a pitfall in interpretation of posttreatment PET/CT in patients with non-Hodgkin lymphoma. Eur J Nucl Med Mol Imaging 40, 1330–1336 (2013). https://doi.org/10.1007/s00259-013-2429-4

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  • DOI: https://doi.org/10.1007/s00259-013-2429-4

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