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The usefulness of 18F-FDG PET/CT for assessing methotrexate-associated lymphoproliferative disorder (MTX-LPD)

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Title: The usefulness of 18F-FDG PET/CT for assessing methotrexate-associated lymphoproliferative disorder (MTX-LPD)
Authors: Watanabe, Shiro Browse this author
Manabe, Osamu Browse this author →KAKEN DB
Hirata, Kenji Browse this author →KAKEN DB
Oyama-Manabe, Noriko Browse this author →KAKEN DB
Hattori, Naoya Browse this author
Kikuchi, Yasuka Browse this author
Kobayashi, Kentaro Browse this author
Toyonaga, Takuya Browse this author
Tamaki, Nagara Browse this author →KAKEN DB
Keywords: Methotrexate-associated lymphoproliferative disorder
Metabolic tumor volume
Total lesion glycolysis
Issue Date: 15-Aug-2016
Publisher: BioMed Central
Journal Title: BMC cancer
Volume: 16
Start Page: 635
Publisher DOI: 10.1186/s12885-016-2672-8
Abstract: Background: Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is a benign lymphoid proliferation or malignant lymphoma in patients who have been treated with MTX. MTX withdrawal and observation for a short period should be considered in the initial management of patients who develop LPD while on MTX therapy. Here we evaluated the diagnostic accuracy and predictive value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for MTX-LPD. Methods: We retrospectively investigated the cases of 15 patients clinically suspected of having MTX-LPD. A total of 324 anatomic regions (207 nodal and 117 extranodal regions) were assessed by 18F-FDG PET/CT and by multi-detector row CT (MDCT). Each anatomic region was classified as either malignant or benign. The uptake of 18F-FDG was assessed semi-quantitatively with the standardized uptake value maximum (SUVmax), the whole-body metabolic tumor volume (WBMTV), and the whole-body total lesion glycolysis (WBTLG) in order to investigate predictive factors of spontaneous regression after the withdrawal of MTX. Results: MTX-LPD lesions were observed in 92/324 (28.4 %) regions. 18F-FDG PET/CT showed 90.2 % sensitivity, 97.4 % specificity, and 95.4 % accuracy, values which were significantly higher than those of MDCT (59.8, 94.8, and 84.9 %, respectively. p < 0.002). After the withdrawal of MTX, 9/15 patients (60.0 %) achieved complete response (CR). The SUVmax, WBMTV and WBTLG values of the CR patients were 9.2 (range 2.8-47.1), 44.3 (range 0-362.6) ml, 181.8 (range 0-2180.9) ml, respectively, which were not significantly different from those of the non-CR patients: 10.6 (range 0-24.9), 15.7 (range 0-250.1) ml, and 97.4 (range 0-1052.1) ml. Conclusions: Although 18F-FDG PET/CT was a useful tool to detect MTX-LPD lesions, none of the 18F-FDG PET parameters before the withdrawal of MTX could be used to predict CR after the withdrawal of MTX.
Type: article
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
国際連携研究教育局 : GI-CoRE (Global Institution for Collaborative Research and Education : GI-CoRE) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 真鍋 治

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