Hematological Malignancies
February 4, 2020
Musculoskeletal Tumors
February 4, 2020

Hematological Malignancies Cases


Case 4: Suspected CNS involvement in A Case of Non-Hodgkin’s Lymphoma


Case History:

46 year old male treated case of Non-Hodgkin’s Lymphoma with relapse and suspected CNS involvement. PET/MRI was done for evaluation and the patient had a series of follow up PET/MRI scans.


Findings:

Axial sections of the brain showed two peripherally enhancing lesions with central diffusion restriction and mild FDG uptake along the rim morphologically representing abscesses (A).
DWI characterizes the rim enhancing brain lesions as abscesses depending on their appearance on ADC maps (B)where thick fluid (pus in this case) appears dark in contrast to a necrotic lesion where the center appears bright.
Coronal Whole-Body PET/MR image(D) showing disease bulk with metabolically active cervical, mediastinal, bilateral axillary and abdominal nodes.


Follow up scan was performed after two months shows an increase in the size of the brain lesions(A, B, C) with marked regression in the lymphadenopathy as seen on the PET MIP image(D).


Case 5: Widespread Non-Hodgkin’s Lymphoma


Case History:

38 year old female with Non-Hodgkin’s lymphoma.


Findings:

PET/MRI (A) and T1 Axial post-contrast (C) and image of the brain and T2 sagittal (E) of the upper cervical spine showing FDG avid intensely enhancing lesions involving the corpus callosum (red arrow). The similar enhancing intramedullary lesion is noted at the C5-C6 level (B, D, E)causing cord expansion (white arrow).

Axial sections through the lower thorax and abdomen showing FDG avid confluent nodal masses in the anterior mediastinum, bilateral hilar groups, periportal and peripancreatic regions with avid deposits in bilateral adrenal glands (green arrow)(E). Additional intraspinal deposits are noted opposite L1-L4 vertebral levels (white arrows) (F, G).

Axial T2(A-C)and Axial PET/MR fused images through the neck and upper thorax (D-E) showing confluencing cervical and mediastinal nodal masses infiltrating the chest wall anteriorly (arrows) with left pleural effusion. WB PET/MRI provides holistic staging in lymphoma.


Case 6: CNS lymphoma


Case History:

63 year old female with H/O fever 15 days along with giddiness, MRI reveals right cerebellar lesion, for evaluation with PET/MRI.


Findings:

Axial FLAIR(A), T1 post-contrast ( C) lesion showed fairly homogenously enhancing lesion in the right cerebellar hemisphere in the peri fourth ventricular region with mild focal increased perfusion on CBV mao(E), equivocal choline: creatine ratios(~1.5) on MRS(B) and mild restricted diffusion on ADC maps (D).


Case 7: CNS Lymphoma


Case History:

22year old male, treated case of NHL retroperitoneum with CNS symptoms, for evaluation with PET/MRI.


Findings:

Axial T2 (A, D), Axial FLAIR (E, F) Axial post-contrast T1, (C, G, I), PET/MR fused (B, H, J) reveal multiple metabolically active enhancing confluence subependymal nodular soft tissue lesions are seen in bilateral lateral ventricles, III & IV ventricles including outlet of the IV ventricle with proximal ventricular dilation ( R>>L), with diffuse sulcal and cisternal effacement suggesting CNS involvement in a treated case on NHL.


Case 8: Follow Up a Case of Non-Hodgkin’s Lymphoma


Case History:

65 year old female with NHL underwent serial PET/MRI.


Findings:

Serial follows up PET MIP images as a part of PET /MRI reveals evidence of treatment response.
In the case of lymphomas, as a matter of fact in all malignancies, serial follow up PET study may be indicated either to assess the response to chemotherapy or a part of surveillance after complete remission. The last decade has seen the immense impact of PET CT on patient management more so because of the PET component. Now since that same PET has been combined with MRI instead of CT, radiation exposure may be tremendously reduced (reduced to 1/3 that too because of the radioactive isotope) in those patients needing serial follow-ups.

Case Study Prepared by:

This short PET-MRI Scan case was compiled by Dr. Sangeeta Taneja and Dr. Amarnath Jena (Nuclear Medicine Physician at PET-Suite @ Indraprastha Apollo Hospital, Sarita Vihar).


Read More about PET-MRI Scan at House Of Diagnostics in Delhi and NCR.

The Simultaneous PET-MRI Scan is currently offered at PET-Suite at Apollo Hospital, Sarita Vihar.