Published in:
01-10-2006 | Image of the month
Changing PET/CT manifestation of neurolymphomatosis
Authors:
Klaus Strobel, Bernhard Pestalozzi, Ilja Ciernik, Niklaus G. Schaefer, Abbas Yousefi Koma, Thomas F. Hany
Published in:
European Journal of Nuclear Medicine and Molecular Imaging
|
Issue 10/2006
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Excerpt
Neurolymphomatosis (NL) is a rare manifestation of lymphoma [
1]. CT and MRI have been used to detect NL, to stage the extent of the nerve involvement and to guide biopsy. Recent reports have demonstrated the value of FDG-PET/CT in patients with NL [
2‐
4]. Here we present the FDG-PET/CT imaging follow-up of a 56-year-old patient with diffuse large B-cell lymphoma initially presenting as stage IE involving the urinary bladder and presacral area. After six cycles of chemotherapy and pelvic radiation therapy, a complete response was documented. However, there was relapse of the lymphoma, restricted to neural structures. In
a–c the PET/CT images demonstrate increased FDG uptake in the cranial nerves, delineated on fused axial images [
b, gasserian ganglion of the trigeminal nerve (
arrows) and
c the cervical and lumbar nerve roots (
arrows)]. The patient was treated with high-dose methotrexate and subsequent radiation therapy. Six weeks after the end of radiation therapy, progressive NL (
d–f) in the brachial (
e,
arrows) and lumbosacral plexus (
f,
arrows) was observed. …