Lymphoma Case 01


Clinical History
42-year-old male patient presented with a painful mass in the right arm, just above the elbow. An excisional biopsy of a right epitrochlear lymph node revealed non-Hodgkin's lymphoma. A PET/CT scan was ordered for further evaluation.

Imaging Findings
NUCLEAR MEDICINE PET/CT
STATED REASON FOR REQUEST: Evaluation of non-Hodgkin's lymphoma
TECHNIQUE: Emission scanning was performed extending from the base of the skull through the pelvis approximately 1 hour post radiotracer injection. Images were reconstructed with and without attenuation correction using the CT attenuation coefficients.
BLOOD GLUCOSE: 90 mg/dL


PET/CT FINDINGS: There was a tiny lymph node within the right axilla, which demonstrated moderate uptake of radiopharmaceutical. There was a left sided epitrochlear lymph node measuring approximately 1.0 cm that also demonstrated moderate uptake. There were scattered areas of mesenteric lymph nodes with mild to moderate uptake. Finally, there was one of the bilateral inguinal lymph nodes which demonstrated glucose avidity and measured approximately 1.0 cm in diameter.

Discussion
There was mild to moderate radiopharmaceutical uptake noted within the right axilla, left epitrochlear region, scattered within the mesentery and within the right inguinal region. These areas corresponded to small lymph nodes and were consistent with malignancy. Chemotherapy was started.

This is good example of how PET/CT can improve the confidence level of the interpreting physician. Those small areas of involvement might have been overlooked on CT alone given their size and location. By having the fused images available, the interpretation of small or borderline lymph nodes became much more definitive.

Data courtesy of Dr. Todd Blodgett, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

Reference: Schiepers C, Filmont JE, Czernin J. PET for staging of Hodgkin's disease and non-Hodgkin's lymphoma. Eur J Nucl Med Mol Imaging 2003;30 Suppl 1:S82-8

* Any of the protocols presented herein are for informational purposes and are not meant to substitute for clinician judgment in how best to use any medical devices. It is the clinician that makes all diagnostic determinations based upon education, learning and experience.