J Nucl Med. 2008; 49 (Supplement 1):178P
Educational Exhibits (Poster Only)Oncology Posters |
The role of PET/CT in the management of HIV-associated lymphoma
Martin Magram2,
Faaiza Mahmoud2,
Robert Ashlock1,
Harisha Kommana1,
Babak Bagheritoolabi1 and
Vasken Dilsizian1
1 Radiology, University of Maryland Medical Center, Baltimore, Maryland;
2 Radiology, VA Maryland Healthcare System, Baltimore, Maryland
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Learning Objectives: 1. Discuss the manifestations of lymphoma in HIV patients. 2. Discuss the role of PET/CT in HIV-associated lymphoma.
Abstract Body: PET/CT has an established role in the initial staging, treatment monitoring, and restaging lymphoma in non-immunocompromised patients. In HIV patients the use of PET/CT for these roles has been less well studied and its role will be more clearly defined in the future. The incidence of lymphoma is 1.6% per year in the HIV population, and in the lymphoma population between 8 and 27% of new cases have HIV. 95% of HIV-associated lymphomas are aggressive B cell lymphomas and the majority of these are intermediate or high grade large cell lymphomas, with the minority high grade small non-cleaved lymphomas, also know as Burkitt’s lymphoma. These aggressive lymphomas are FDG avid and PET/CT can be used in their management. However, HIV patients have metabolically active benign lymph nodes, which complicates PET/CT interpretation. Only 3% of HIV associated lymphomas are low grade B cell lymphomas, and T cell lymphomas are rare. PET/CT is of less value in these less FDG avid lymphomas. HIV-associated lymphoma may present as primary CNS lymphoma, systemic lymphoma, primary effusion lymphoma, or Hodgkin’s disease. CNS lymphoma usually occurs as an isolated central nervous system disease in severely immunocompromised HIV patients. PET/CT and thallium-201 are of value in differentiating this lymphoma from toxoplasmosis. CNS lymphoma is treated with radiation therapy and possibly chemotherapy. The other HIV-associated lymphomas are treated with full or reduced dose chemotherapy while maintaining antiretroviral therapy. Case examples are provided of the use of PET/CT in the management of HIV-associated lymphoma.
