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Increased Metabolic Activity in the Thymus Gland Studied with ¹⁸F-FDG PET: Age Dependency and Frequency After Chemotherapy

Division of Nuclear Medicine and Department of Diagnostic Radiology, School of Medicine, Albert-Ludwigs University of Freiburg, Freiburg, Germany

This study was designed to evaluate the age dependency of ¹⁸F-FDG uptake in the thymus and the frequency of PET confirmation of thymus hyperplasia after chemotherapy in cancer patients. Methods: Whole-body FDG PET recordings of 168 patients were retrospectively examined for a retrosternal lesion in the anterior mediastinum that was attributable to the thymus. The patients were assigned to the following four groups: children with malignant lesions before the first therapy (group Ia; n = 15; mean age ± SD, 11.9 ± 3.7 y), children with malignant disease after chemotherapy (group Ib; n = 12; mean age, 10.3 ± 5.0 y), adults with histologically confirmed malignant lymphoma before the first therapy (group IIa; n = 37; mean age, 43.9 ± 16.7 y), and adult lymphoma patients 3 wk to 4 mo after chemotherapy (group IIb; n = 104; mean age, 40.9 ± 14.6 y). Results: Increased FDG accumulation in the thymus was seen in 11 patients (73%) of group Ia and 9 patients (75%) of group Ib. Thymus hyperplasia was found in 5 patients (5%) of group IIb. The eldest of these 5 patients was 25 y old. No increased FDG accumulation in the thymus was observed in any of the group IIa patients. In cases of visible FDG uptake in the thymus, standardized uptake values did not exceed 4. Conclusion: FDG accumulation in the thymus is a common finding in children and can occasionally be observed in young adults after chemotherapy. Knowledge of the characteristics of a typical retrosternal lesion in conjunction with the clinical history allows avoidance of diagnostic uncertainty and unnecessary procedures.

Key Words: thymus hyperplasia • FDG PET • chemotherapy

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