Pramod Gupta MD, Presenter: Nothing to Disclose

Erich Lee, Abstract Co-Author: Nothing to Disclose

Fabio Ponzo MD, Abstract Co-Author: Nothing to Disclose

Elissa L. Kramer MD, Abstract Co-Author: Nothing to Disclose

Karen Mourtzikos MD, Abstract Co-Author: Nothing to Disclose

Positron Emission Tomography (PET) with FDG is used now in lymphoma patients to stage, assess treatment response and predict outcome. Splenic evaluation is key, as it affects clinical management and prognosis. However, FDG uptake in the spleen with lymphomatous involvement has not been well studied. We aimed to characterize FDG splenic uptake in lymphoma patients.

We retrospectively studied 31 lymphoma patients who had abnormal splenic uptake on initial staging PET [7 with Hodgkin’s disease (HD) and 24 with non-Hodgkin’s lymphoma (NHL), M: F= 18:13,aged 14-83 years]. We considered splenic uptake greater than liver uptake abnormal and characterized it as diffuse or focal. Standardized uptake value (SUV) was measured in mid spleen, on focal lesions, and right lobe of the liver. We assessed spleen size using splenic index. Extrasplenic disease was also noted. Lymphomatous splenic involvement was confirmed by clinical follow-up in 16 and follow-up PET scans after chemotherapy in 15 patients, 3-6 months after the first PET.

All 7 patients with HD had diffuse FDG uptake (SUV 3.7-16.7,mean 6.0±4.8). Of 24 patients with NHL, 16(67%) had diffuse FDG uptake (SUV 2.3- 8.2,mean 4.2±1.5) and 8(33%) had focal uptake (2 patients had 1 focus, 1 had 2 foci & 5 had multiple foci, SUV 4.7-15.6,mean 8.1±3.9). Eight (26%) patients had normal spleen size (2 with HD;6 with NHL). 4/8(50%)patients showed diffuse and 4/8 showed focal uptake. Other 23(74%) patients had splenomegaly (5 with HD;18 with NHL). 19/23(83%)patients showed diffuse and 4/23(17%) showed focal uptake. Extrasplenic disease (lymph nodes, liver or bone) was seen in all patients. The 11/15 patients with follow-up PET after chemotherapy had total resolution of abnormal splenic and extrasplenic uptake. 4/15 patients had hematopoietic growth factors within 5 days of PET and showed diffuse bone marrow and splenic uptake likely due to hematopoiesis.

Splenic involvement in HD usually shows diffuse increased FDG uptake, while in NHL patients, it can be diffuse or focal. Focal uptake is more common in normal sized spleen. When the spleen is involved, extrasplenic disease is always present and should be carefully looked for on PET.

Gupta, P, Lee, E, Ponzo, F, Kramer, E, Mourtzikos, K, Fluorodeoxyglucose (FDG) Uptake Pattern in Splenic Lymphoma.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4406957.html