title: Altered FDG uptake patterns in pediatric lymphoblastic lymphoma patients receiving induction chemotherapy that includes very high dose corticosteroids.
abstract: BACKGROUND
  Altered FDG uptake patterns were noted in certain lymphoblastic lymphoma patients during therapy.
  
  
  OBJECTIVE
  To describe these altered FDG uptake patterns and their relationship to chemotherapy.
  
  
  METHODS
  Thirty-five FDG PET or PET/CT scans obtained in 11 children with lymphoblastic lymphoma were retrospectively reviewed. FDG uptake patterns were recorded. SUV measurements were performed in liver and facial soft tissues. Results were correlated with induction chemotherapy regimens.
  
  
  RESULTS
  Six of the children had transiently altered FDG uptake with increased uptake in the superficial soft tissues, most notably involving the face. Altered uptake was noted approximately 1 month after initiation of chemotherapy and subsequently resolved. Hepatic uptake was transiently reduced on the 1-month scan in all six children with increased facial uptake. No significant FDG uptake in lymphoma was seen on five of six scans with altered uptake; however, two of these five affected children had FDG uptake in lymphoma on the next follow-up examination. Blood glucose levels in the affected children were in the normal range. All six children with altered FDG uptake received the same induction chemotherapy regimen, which included very high doses of corticosteroids.
  
  
  CONCLUSIONS
  Children with lymphoblastic lymphoma on induction chemotherapy protocols including very high doses of corticosteroids transiently demonstrated altered FDG uptake patterns, including increased superficial facial uptake and reduced hepatic uptake. The facial uptake is probably the FDG PET equivalent of Cushingoid facies. Caution in interpreting scans with this altered FDG uptake pattern is suggested, as uptake at sites of lymphomatous involvement may potentially be affected.
authors: Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA. susan.sharp@cchmc.org
authors: Susan E
authors: SE
authors: Sharp
authors: Michael J
authors: MJ
authors: Gelfand
authors: Michael J
authors: MJ
authors: Absalon
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D016477:Artifacts; D002648:Child; D002675:Child, Preschool; D003480:Cushing Syndrome / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000378:metabolism; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods; D008297:Male; D008657:Metabolic Clearance Rate / Q000187:drug effects; D049268:Positron-Emission Tomography / Q000379:methods; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000000981:diagnostic imaging* / Q000378:metabolism*; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D014018:Tissue Distribution / Q000187:drug effects
chemical_list: D000305:Adrenal Cortex Hormones; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18