18F-FDG pet/ct/mri fusion images showing cranial and peripheral nerve involvement in neurolymphomatosis

Ana Carolina Trevisan, Fernanda Borges Ribeiro, Emerson Nobuyuki Itikawa, Leonardo Santos Alexandre, Felipe Arriva Pitella, Antonio Carlos Santos, Belinda Pinto Simões, Lauro Wichert-Ana

Indian Journal of Nuclear Medicine 2017 32(1):77-78

We report a 56-year-old female patient with non-Hodgkin's diffuse large B cell lymphoma (NHL) who, on magnetic resonance imaging (MRI) with a T1 weighted and gadolinium-enhanced imaging, was found to have thickening and infiltration in 75% of peripheral nerves of the patient and enlargements of cranial nerves, possibly related to lymphomatous infiltration. Subsequent positron emission tomography/computed tomography (PET/CT) using 18F-labeled 2-deoxy-2-fluoro-d-glucose (18F-FDG) showed widespread active involvement of the cervical plexus, bilateral peripheral nerves, right femoral nerve, the parasellar region of the skull, and marked hypermetabolism in the left trigeminal ganglia. This case re-emphasizes that while CT and MRI provide anatomical details, 18F-FDG PET/CT images better delineate the metabolic activity of neurolymphomatosis (NL) in the peripheral and central nervous system.

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