Open AccessPrimary Central Nervous System Lymphoma: Diagnostic Yield of Whole-Body CT and FDG PET/CT for Initial Systemic Imaging
Author(s) -
Chong Hyun Suh,
Ho Sung Kim,
Ji Eun Park,
Sung Eun Jung,
Choong Gon Choi,
Sang Joon Kim
Publication year - 2019
Publication title -
radiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.118
H-Index - 295
eISSN - 1527-1315
pISSN - 0033-8419
DOI - 10.1148/radiol.2019190133
Subject(s) - medicine , primary central nervous system lymphoma , radiology , confidence interval , biopsy , lymphoma , retrospective cohort study , nuclear medicine , positron emission tomography , surgery
Background Updated guidelines for suspected primary central nervous system lymphoma (PCNSL) are lacking. Purpose To investigate the diagnostic yield of initial systemic imaging in patients suspected of having PCNSL by using contrast material-enhanced chest and abdominopelvic CT and/or whole-body fluorine 18 fluorodeoxyglucose (FDG) PET/CT. Materials and Methods This retrospective study included 304 patients examined at a single tertiary hospital between January 1998 and October 2018. Consecutive adults (age >18 years) who were confirmed to have newly diagnosed PCNSL on the basis of findings at stereotactic brain biopsy were recruited. All patients were examined with contrast-enhanced chest and abdominopelvic CT and/or whole-body FDG PET/CT before initiation of PCNSL treatment. The diagnostic yield of CT and PET/CT was determined before therapy and at the time of recurrence in the brain. A χ 2 test was performed to compare the diagnostic yield according to study date in order to assess for possible changes in technology during the study period. Results A total of 304 patients (180 men with a mean age [±standard deviation] of 58 years ± 13 and 124 women with a mean age of 59 years ± 13) were included. The diagnostic yield of CT and PET/CT for initial staging was 2% (six of 304 patients; 95% confidence interval [CI]: 0.7%, 4.3%), and these tests yielded false-positive findings in 13 of the 304 patients (4%; 95% CI: 2.3%, 7.2%). Diagnostic yield did not differ between patients evaluated before 2009 and those evaluated in 2009 and later ( P = .82). The diagnostic yield of systemic imaging at recurrence was 1.5% (one of 68 patients; 95% CI: 0.0%, 7.9%), and these tests yielded false-positive findings in four of those 68 patients (6%; 95% CI: 1.6%, 14.4%). Conclusion Contrast-enhanced chest and abdominopelvic CT and/or whole-body fluorine 18 fluorodeoxyglucose PET/CT for initial staging, as well as for recurrence of suspected primary central nervous system lymphoma, had a low diagnostic yield. © RSNA, 2019 See also the editorial by Jara in this issue.