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PET/CT in Lymphoma: Prospective Study of Enhanced Full-Dose PET/CT Versus Unenhanced Low-Dose PET/CT

Beatriz Rodríguez-Vigil1, Nieves Gómez-León1, Inmaculada Pinilla1, Dolores Hernández-Maraver2, Juan Coya3, Luis Martín-Curto3 and Rosario Madero4

1 Department of Radiology, University Hospital La Paz, Madrid, Spain; 2 Department of Haematology, University Hospital La Paz, Madrid, Spain; 3 Department of Nuclear Medicine, University Hospital La Paz, Madrid, Spain; and 4 Department of Statistics, University Hospital La Paz, Madrid, Spain


Figure 1
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  		FIGURE 1.  27-year-old woman with HD (nodular sclerosis) who underwent PET/CT for initial staging. (A) Axial low-dose unenhanced CT showed no pathologic findings in upper abdomen. Small finding in splenic hilum (arrow) was considered to be vessel or accessory spleen. (B) Axial full-dose contrast-enhanced CT at same level demonstrated small lymphadenopathy at splenic hilum that, because of its small diameter (arrows), was not considered pathologic. No other abnormalities were seen in abdomen or pelvis. (C) Axial PET at same level showed, next to splenic hilum, a small, focal area of increased 18F-FDG uptake whose anatomic origin and location were difficult to determine (arrows). (D) Axial full-dose enhanced PET/CT clearly demonstrated that pathologic uptake corresponded to small adenopathy in splenic hilum (arrows). Mediastinal and cervical disease were also assessed (not shown). Because no other abdominal or pelvic disease was found, full-dose PET/CT led to upstaging from stage II to stage III.

 

Figure 2
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  		FIGURE 2.  Same patient as in Figure 1, after 3 cycles of chemotherapy. (A) Axial contrast-enhanced CT at level of splenic hilum showed no abnormalities. (B) Axial PET at same level demonstrated no pathologic 18F-FDG uptake. (C) Findings on axial PET/CT image were also normal. Supra- and infradiaphragmatic nodal disease responded well to treatment, and response was complete at end of chemotherapy (not shown).

 




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