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Atypical sites of FDG avidity are unlikely to represent lymphoma, but may reveal incidental pathology, when staging pediatric Hodgkin's disease.

¹ Division of Nuclear Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts

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Objectives: During staging of pediatric Hodgkin's disease (HD), non-specific FDG uptake may drive additional diagnostic procedures to exclude additional sites of disease, even if clinical suspicion for HD is low. The aim of this study was to characterize atypical sites of FDG uptake in pediatric HD and to determine the need for further evaluation of these findings.

Methods: A retrospective review was performed in fifty-five patients (age 9-17 y) who underwent initial staging for HD with whole body ¹⁸F-FDG-PET and contrast enhanced CT of the neck and torso between 2004 and 2007 at Children’s Hospital.

Results: In 9 of 55 subjects, 10 abnormal FDG-PET findings were atypical of HD and not fully explained with CT correlation. At 3 sites of atypical uptake with abnormal correlative findings on CT, surgical biopsy diagnosed terminal ileitis, paraspinal ganglioneuroma, and inflammatory lymph nodes. At 4 sites of atypical FDG-avidity without CT correlate, biopsy revealed erythema nodosum, x-ray revealed non-ossifying fibroma, bone scan excluded an osseous abnormality of a rib, and clinical correlation identified a recent marrow biopsy site. In 3 cases, atypical FDG uptake with no CT correlate underwent no further evaluation. All 9 patients had a complete response to theray, without relapse at follow-up 3-37 months after completion of therapy.

Conclusions: Non-specific FDG uptake is a frequent finding when staging pediatric HD. If the location of an isolated site of FDG uptake is atypical for HD, then it is unlikely to represent HD, and staging should not be changed. Additional invasive evaluation may be unnecessary. However, abnormal correlative findings on CT may indicate that further evaluation is needed to diagnose incidental pathology unrelated to HD.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Zukotynski, K. Articles by Grant, F. PubMed Articles by Zukotynski, K. Articles by Grant, F.