Efficacy of Positron Emission Tomography/Computed Tomography in Gastric Mucosa-associated Lymphoid Tissue Lymphoma

Jin Won Hwang; Sam Ryong Jee; Sang Heon Lee; Ji Hyun Kim; Sang Yong Seol; Seok Mo Lee

doi:10.4166/kjg.2016.67.4.183

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Hwang, Jee, Lee, Kim, Seol, and Lee: Efficacy of Positron Emission Tomography/Computed Tomography in Gastric Mucosa-associated Lymphoid Tissue Lymphoma

Original Article

Korean J Gastroenterol 2016;67(4):183-188.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.67.4.183

Efficacy of Positron Emission Tomography/Computed Tomography in Gastric Mucosa-associated Lymphoid Tissue Lymphoma

Jin Won Hwang, Sam Ryong Jee, Sang Heon Lee, Ji Hyun Kim, Sang Yong Seol, Seok Mo Lee¹

Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

¹Department of Nuclear Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

Correspondence to: Sam Ryong Jee, Department of Gastroenterology, Inje University Busan Paik Hospital, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea. Tel: +82-51-890-6536, Fax: +82-51-890-6341, E-mail: srjee@inje.ac.kr

Received 22 February 2016 Revised 25 March 2016 Accepted 31 March 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

This study evaluated the diagnostic efficacy of fluorine-18 fluorodeoxyglucose PET/CT (F-18 FDG PET/CT) for patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma and examined the association between FDG avidity and the clinical factors affecting lesions.

Methods

Among the patients diagnosed with gastric MALT lymphoma, 16 who underwent a PET/CT for gastric MALT lymphoma were semi-quantitatively and qualitatively tested for FDG avidity of lesions in the stomach. Retrospectively collected data was analyzed to investigate the clinicoradiological factors and endoscopic findings between the patients with positive F-18 FDG PET/CT scans and those with negative scans.

Results

Eight of the 16 patients showed FDG avidity. When comparing the size of lesions in the stomach, the patients with FDG avidity had significantly larger lesions than those without (28.8 mm vs. 15.0 mm, p=0.03). The FDG-avid group has a significantly higher rate of positive CT scans than the non-avid group (75% vs. 13%, p=0.03). According to the endoscopic finding of the lesions, FDG avidity was pronounced with 75% of the protruding tumors, and 100% of the erosive-ulcerative types, which are a type of depressed tumors.

Conclusions

When gastric MALT lymphoma is large, when lesions are found using abdominal CT scans, and the macroscopic appearance of a lesion is that of a protruding tumor or erosive-ulcerative type of depressed tumor, there is a high probability that such patients may have a positive F-18 FDG PET/CT scan.

Keywords: Positron emission tomography, Stomach, Lymphoma, B-cell, marginal zone

References

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Fig. 1.

Flowchart shows patient inclusion. MALT, mucosa-associated lymphoid tissue; F-18 FDG, fluorine-18 fluorodeoxyglucose.

Fig. 2.

This case shows the fluorine-18 fluorodeoxyglucose (F-18 FDG) uptake in an erosive-ulcerative type of gastric mucosa-associated lymphoid tissue lymphoma. (A) A 56-year-old female patient had an erosive-ulcerative lesion on the antral posterior wall of the stomach. (B) Maximum standardized uptake value of F-18 FDG uptake (arrow) was 6.2. (C) Abdomen CT shows irregular wall thickening at the gastric antrum.

Fig. 3.

This case shows no fluorine-18 fluorodeoxyglucose (F-18 FDG) uptake in a discolored-scar type of gastric mucosa-associated lymphoid tissue lymphoma. (A) A 53-year-old male patient had a discolored-scar lesion on the greater curvature in lower body of the stomach. (B) F-18 FDG PET revealed no significant F-18 FDG uptake in the stomach. (C) Abdomen CT shows no wall thickening at the gastric body.

Table 1.

Comparison between Patients with Positive F-18 FDG Uptake and Patients with Negative F-18 FDG Uptake

	Positive F-18 FDG uptake (n=8)	Negative F-18 FDG uptake (n=8)	p-value
Age (yr)	56±9	59±14	0.51
Sex (male)	5/8 (63)	4/8 (50)	0.63
Laboratory findings
WBC (/mm³)	6,302±1,601	6,382±1,419	0.88
PMN (%)	57.6±6.3	56.3±9.0	0.38
Hemoglobin (g/dL)	13.4±1.6	14.1±1.3	0.33
Platelet (K/mm³)	253±61	281±97	0.72
LDH (U/L)	190±51	186±36	0.84
T-protein (g/dL)	7.4±0.5	7.5±0.5	0.72
Albumin (g/dL)	4.0±0.6	4.3±0.5	0.23
HP infection	5/8 (63)	3/8 (38)	0.62
Success of HP eradication	3/4 (75)	1/4 (25)	0.74
Other treatment			0.51
Chemotherapy	4/8 (50)	2/8 (25)
Radiation therapy	1/8 (12)	1/8 (12)
Operation	1/8 (12)	0/8 (0)
Complete remission	8/8 (100)	6/8 (75)	0.56
Ann Arbor stage			0.20
Stage I	5/8 (63)	8/8 (100)
Stage II	2/8 (25)	0/8 (0)
Stage III	0/8 (0)	0/8 (0)
Stage IV	1/8 (12)	0/8 (0)
Positive CT findings	6/8 (75)	1/8 (13)	0.03
Bone marrow involvement	0/5 (0)	0/3 (0)	1.00
PET uptake sites other than stomach	7/8 (88)	5/8 (63)	0.57
Endoscopic findings
Number of lesions			0.07
Single	6/8 (75)	2/8 (25)
Multiple	2/8 (25)	2/8 (25)
Diffuse	0/8 (0)	4/8 (50)
Location of lesion			0.47
Upper	1/8 (13)	2/8 (25)
Middle	3/8 (38)	4/8 (50)
Lower	3/8 (38)	0/8 (0)
Multiple	1/8 (12)	2/8 (25)
Size of lesion (mm)	28.8±10.9	15.0±7.1	0.03
Endoscopic type			0.71
Chronic gastritis-like	1/8 (12)	4/8 (50)
Depressed	4/8 (50)	3/8 (38)
Protruding	3/8 (38)	1/8 (12)

Values are presented as mean±SD or n (%).

F-18 FDG, fluorine-18 fluorodeoxyglucose; WBC, white blood cell PMN, polymorphonuclear neutrophil; HP, Helicobacter pylori.

Table 2.

Endoscopic Classification of Gastric MALT Lymphoma and F-18 FDG Uptake Patterns

Endoscopic classification	Subtype	Positive
Chronic gastritis-like tumors (n=5)	Atrophic type (n=4)	1
	Nodular arthritis type (n=1)	0
Depressed tumors (n=7)	Erosive-ulcerative type (n=4)	4
	Discolored-scar type (n=3)	0
Protruding tumors (n=4)	Thickened-fold type (n=3)	2
	Single-protrusion type (n=1)	1
	Multiple-protrusion type (n=0)	0

MALT, mucosa-associated lymphoid tissue; F-18 FDG, fluorine-18 fluorodeoxyglucose.

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