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Increased 18F-FDG accumulation in the tonsils after chemotherapy for pediatric lymphoma: a common physiological phenomenon

  • Chio OkuyamaEmail author
  • Shigenori Matsushima
  • Motoki Nishimura
  • Kei Yamada
Short Communication
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Abstract

Objective

Increased 18F-fluorodeoxyglucose (FDG) uptake in the tonsils after the completion of chemotherapy in patients with lymphoma may be misdiagnosed as tumor recurrence. This study aimed to investigate the changes in physiological FDG uptake in the tonsils during and after chemotherapy in pediatric patients with lymphoma.

Methods

A total of 47 FDG-PET/CT scans acquired from 13 pediatric patients with lymphoma (before chemotherapy [preC] = 9; during chemotherapy [durC] = 12; within 1 month after the end of chemotherapy [endC] = 11; and after achieving complete response [postC] = 15) were retrospectively included in this study. FDG uptake in the palatine tonsils was assessed using maximum standardized uptake value (SUVmax). The relative size of the palatine tonsils was calculated as the tonsil-pharyngeal ratio (TPR). Serial changes in the SUVmax and TPR were evaluated.

Results

The mean SUVmax was 3.7 ± 1.7, 2.6 ± 0.7, 2.3 ± 0.8, and 6.2 ± 1.6, at the preC, durC, endC, and postC scans, respectively (p < 0.0001); TPR was 59.0 ± 11.2%, 58.3 ± 9.4%, 54.4 ± 7.9%, and 62.2 ± 12.0% in these groups, respectively, with no significant inter-group differences. TPR and SUVmax showed no correlation.

Conclusions

Increased physiological FDG uptake in the tonsils is commonly observed after the completion of chemotherapy, even in the absence of reactive hypertrophy.

Keywords

FDG-PET/CT Reactive hypertrophy Tonsil Chemotherapy 

Notes

Acknowledgements

This study was partly supported by the grants as a commissioned research (K.Y was received from Nihon Medi-Physics Co. Ltd). We thank Editage (http://www.editage.jp) for English language editing.

References

  1. 1.
    Cheson BD. New staging and response criteria for non-Hodgkin lymphoma and Hodgkin lymphoma. Radiol Clin N Am. 2008;46:213–23 vii.CrossRefPubMedGoogle Scholar
  2. 2.
    Cheson BD. Role of functional imaging in the management of lymphoma. J Clin Oncol. 2011;29:1844–54.CrossRefPubMedGoogle Scholar
  3. 3.
    Seam P, Juweid ME, Cheson BD. The role of FDG-PET scans in patients with lymphoma. Blood. 2007;110:3507–16.CrossRefPubMedGoogle Scholar
  4. 4.
    Burrell S, Van den Abbeele AD. 2-Deoxy-2-[F-18] fluoro-D-glucose-positron emission tomography of the head and neck: an atlas of normal uptake and variants. Mol Imaging Biol. 2005;7:244–56.CrossRefPubMedGoogle Scholar
  5. 5.
    Shammas A, Lim R, Charron M. Pediatric. FDG PET/CT: physiologic uptake, normal variants, and benign conditions. Radiographics. 2009;29:1467–86.CrossRefPubMedGoogle Scholar
  6. 6.
    Nakatani K, Nakamoto Y, Watanabe K, Saga T, Higashi T, Togashi K. Roles and limitations of FDG PET in pediatric non-Hodgkin lymphoma. Clin Nucl Med. 2012;37:656–62.CrossRefPubMedGoogle Scholar
  7. 7.
    Chen CH, Hsiao CC, Chen YC, Ko SF, Huang SH, Hsieh KS, et al. Rebound thymic hyperplasia after chemotherapy in children with lymphoma. Pediatr Neonatol. 2017;58:151–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Kaste SC, Howard SC, McCarville EB, Krasin MJ, Kogos PG. Hudson MM 18F-FDG-avid sites mimicking active disease in pediatric Hodgkin’s. Pediatr Radiol. 2005;35:141–54.CrossRefPubMedGoogle Scholar
  9. 9.
    Hudson MM, Krasin MJ, Kaste SC. PET imaging in pediatric Hodgkin’s lymphoma. Pediatr Radiol. 2004;34:190–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Goethals I, Hoste P, De Vriendt C, Smeets P, Verlooy J, Ham H. Time-dependent changes in 18F-FDG activity in the thymus and bone marrow following combination chemotherapy in paediatric patients with lymphoma. Eur J Nucl Med Mol Imaging. 2010;37:462–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Weinblatt ME, Zanzi I, Belakhlef A, Babchyck B, Kochen J. False-positive FDG-PET imaging of the thymus of a child with Hodgkin’s disease. J Nucl Med. 1997;38:888–90.PubMedGoogle Scholar
  12. 12.
    Hosokai R, Imai C, Takachi T, Yoshida S, Iwabuchi H, Imamura M. Reactive tonsillar enlargement with strong 18F-FDG uptake after chemotherapy for tonsillar diffuse large B-cell lymphoma. J Pediatr Hematol Oncol. 2011;33:e87–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Feio P di SQ, Gomes CBF, Nogueira AS, Almeida LY, Vassallo J, Soares FA, et al. Reactive tonsillar enlargement showing strong 18F-FDG uptake during the follow-up of follicular lymphoma. Head Neck Pathol. 2013;7:258–62.CrossRefGoogle Scholar
  14. 14.
    Oguz A, Karadeniz C, Citak EC, Conly NA, Ileri F, Boyunaga O, et al. Thymic and adenotonsillar enlargement after successful treatment of malignancies. Pediatr Hematol Oncol. 2005;22:423–35.CrossRefPubMedGoogle Scholar
  15. 15.
    Tokuc G, Oktem S, Genc A. Nasopharyngeal lymphoid hyperplasia after therapy for childhood lymphomas. Acta Oncol. 2006;45:618–20.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2019

Authors and Affiliations

  1. 1.Division of PET ImagingShiga Medical Center Research InstituteMoriyamaJapan
  2. 2.Department of Radiology, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan

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