PMC4729018_01
PET/CT maximum intensity projection images for initial staging showing widespread disease involvement of lymph nodes both above and below the diaphragm (a) with splenic and marrow involvement. Fused PET/CT (b), and PET alone (c) sagittal midline sections show heterogeneous marrow involvement of the sternum, multiple vertebrae, and the pubis. The interim PET (d-f) showed significant resolution in the abnormal FDG uptake noted in the initial scan, with two foci of patchy uptake in the abdominal region localizing to lumbar vertebrae (arrows in d-f). End of therapy PET/CT (g-i) shows no significant change in tracer distribution except for the persistent heterogeneous FDG uptake (SUVmax value 3.8) in vertebrae
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F1
T-cell-rich diffuse large B-cell lymphoma (DLBCL) was established after lymph nodal biopsy. The patient underwent a baseline positron emission tomography/computed tomography (PET/CT) for initial staging, which showed widespread disease involvement of the lymph nodes [the largest measuring 2.7 x 0.4 cm in the right hilar region; maximum standardized uptake (SUVmax) value 15.6] both above and below the diaphragm [Figure 1a], with splenic and marrow involvement (SUVmax value 12.5). Fused PET/CT [Figure 1b] and PET alone [Figure 1c] sagittal midline sections show heterogeneous marrow involvement of the sternum, multiple vertebrae, and the pubis. The interim PET [Figure 1d-f] showed significant resolution in the abnormal fluorodeoxyglucose (FDG) uptake noted in the initial scan. Figure 1d-f). Few faint FDG avid nodes (retroperitoneal, with the largest measuring ~ 1.1 x 1.0 cm) were also noted and the scan was interpreted as minimal metabolically active residual disease with possibly persistent marrow disease. The patient then underwent another two cycles of R-CHOP regimen and was then referred for assessment at the end of the therapy [Figure 1g-i].