Changing PET/CT manifestation of neurolymphomatosis

Excerpt

Neurolymphomatosis (NL) is a rare manifestation of lymphoma [1]. CT and MRI have been used to detect NL, to stage the extent of the nerve involvement and to guide biopsy. Recent reports have demonstrated the value of FDG-PET/CT in patients with NL [2‐4]. Here we present the FDG-PET/CT imaging follow-up of a 56-year-old patient with diffuse large B-cell lymphoma initially presenting as stage IE involving the urinary bladder and presacral area. After six cycles of chemotherapy and pelvic radiation therapy, a complete response was documented. However, there was relapse of the lymphoma, restricted to neural structures. In a–c the PET/CT images demonstrate increased FDG uptake in the cranial nerves, delineated on fused axial images [b, gasserian ganglion of the trigeminal nerve (arrows) and c the cervical and lumbar nerve roots (arrows)]. The patient was treated with high-dose methotrexate and subsequent radiation therapy. Six weeks after the end of radiation therapy, progressive NL (d–f) in the brachial (e, arrows) and lumbosacral plexus (f, arrows) was observed. …