Vol 26 (2023): Continuous Publishing
Clinical vignette
Published online: 2023-07-13

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Neurolymphomatosis diagnosed on [18F]FDG PET/CT

Yassir Benameur12, Omar Ait Sahel1, Salah Nabih Oueriagli1, Abderrahim Doudouh13
Nucl. Med. Rev 2023;26:96-97.

Abstract

Fluorine-18-deoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) has been shown to be superior to other conventional imaging modalities in the detection of extra-nodal lymphomatous localizations. Especially in neurolymphomatosis which is rarely encountered in high-grade lymphomas. We report a case of a woman diagnosed with non-Hodgkin lymphoma, whose initial staging with [18F]FDG PET/CT showed increased [18F]FDG uptake along the brachial and sacral plexuses. [18F]FDG PET/CT remains the most appropriate diagnostic tool in these cases, whose prognosis is often poor.

Clinical vignette

Nuclear Medicine Review 2023, 26, 96–97

DOI: 10.5603/NMR.2023.0012

Copyright © 2023 Via Medica

ISSN 1506–9680, e-ISSN 1644–4345

Neurolymphomatosis diagnosed on [18F]FDG PET/CT

Yassir Benameur12Omar Ait Sahel1Salah Nabih Oueriagli1Abderrahim Doudouh13
1Department of Nuclear Medicine, Mohammed V Military Teaching Hospital, Rabat, Morocco
2Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
3Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco

[Received: 22 II 2022; Accepted: 26 VI 2023]

Correspondence to: Yassir Benameur, Department of Nuclear Medicine, Mohammed V Military Teaching Hospital, Mohammed V University of Rabat, Morocco, phone: +212661209162; e-mail: benameur.yassir@gmail.com

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

Fluorine-18-deoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) has been shown to be super­ior to other conventional imaging modalities in the detection of extra-nodal lymphomatous localizations. Especially in neurolympho­matosis which is rarely encountered in high-grade lymphomas. We report a case of a woman diagnosed with non-Hodgkin lymphoma, whose initial staging with [18F]FDG PET/CT showed increased [18F]FDG uptake along the brachial and sacral plexuses. [18F]FDG PET/CT remains the most appropriate diagnostic tool in these cases, whose prognosis is often poor.
KEY words: neurolymphomatosis; FDG-PET/CT; non-Hodgkin lymphoma
Nucl Med Rev 2023; 26, 96–97

A 38-year-old woman with diffuse large B-cell lymphoma, diagnosed after a left cervical lymph node biopsy, presented with severe neuropathic-type pain radiating down her right thigh. A few days later, the patient developed numbness in her left leg, followed by weakness. This weakness became bilateral, resulting in bilateral foot drop. An fluorine-18-deoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) was done as an initial extension of her lymphomatous disease and objectified linear abnormal uptake along both brachial plexus, in both sacral plexus, and the bilateral sciatic nerves. A nerve biopsy was not performed due to clinical circumstances. The combination of clinical history, physical examination, and PET/CT were used to confirm the final diagnosis of neurolymphomatosis. Interim [18F]FDG PET/CT performed after four chemotherapy cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-mini-CHOP) demonstrated complete resolution at these sites.

Neurolymphomatosis (NL) is a rare neurological disorder characterized by the infiltration of malignant lymphocytes into the peripheral nerves, resulting in a variety of neurological symptoms [1] almost always associated with B-cell non-Hodgkin’s lymphoma, occasional cases have been reported to be associated with T-cell lymphomas, with an estimated prevalence of 0.2% of all non-Hodgkin lymphomas [2]. The clinical signs and symptoms of NL can vary depending on the specific nerves involved and the extent of nerve infiltration. In most cases, they are non-specific and can be caused by other neurological conditions such as paraneoplastic neuropathies, chronic inflammatory radiculoneuropathies, neurofibromatosis, and malignant tumors of the peripheral nerve sheath [3]. It is usually difficult to diagnose NL using conventional imaging modalities, in this context [18F]FDG PET/CT has an important place, it allows the lesion to be accurately localized and gives an indication of the metabolic activity of the lesion, which provides useful information on the differential diagnostics [4]. There is no consensus treatment regime for NL, most patients undergo systemic chemotherapy alone or combined with intrathecal chemotherapy or external beam radiotherapy [5]. Unfortunately, the prognosis remains extremely poor once NL has developed despite the administration of high-dose methotrexate and rituximab-containing chemotherapy with or without auto-stem cell transplant [6].

[18F]FDG PET/CT imaging is the most sensitive modality for detecting NL and it excels in identifying extracranial disease. This case demonstrates how hybrid imaging plays an important role in detecting and monitoring NL.

Conflicts of interest

The authors declare no conflicts of interest.

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