False positive PET-CT result after treatment of a patient with diffuse large B-cell lymphoma. Clinical case

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Abstract

The use of 18F-fluorodeoxyglucose positron emission tomography (PET-СT) to determine the initial stage and assess response to treatment in aggressive lymphomas is considered the standard. Evaluation of bone marrow infiltration in PET-CT with 18F-fluorodeoxyglucose usually allows to distinguish normal regenerating bone marrow after chemotherapy by its characteristic absorption.

A 54-year-old patient was diagnosed with diffuse large B-cell lymphoma with focal lesions in the lymph nodes and bone marrow with osteodestruction of the lytic type. Therapy at the A.F. Tsyb Medical Radiological Research Center consisted of 6 cycles of R-EPOCH with intrathecal administration of drugs for the prevention of neuroleukemia (dexamethasone + cytarabine + methotrexate), completed in December 2022. On intermediate PET-CT after 2 cycles, the glycolysis intensity was completely normalized. During the observation in February 2023, PET-CT showed an increase in the level of metabolism in one of the foci of osteodestruction in the pelvic bones. A guided biopsy of the lesion in March 2023 was performed, morphological conclusion: absence of signs of diffuse large B-cell lymphoma, elements of hematopoiesis of the bone marrow. In June 2023, repeated PET-CT showed continuing increase in contrast accumulation in the previously identified foci. Trephine biopsy in July 2023 showed a picture of hematopoietic foci in the bone marrow, a sign of remission. PET-CT scan in December 2023 showed a decrease in the intensity of glycolysis in the foci in the pelvic bones confirming remission of the disease.

In the era of rituximab, false-positive PET-CT results are detected with greater frequency, therefore, their assessment and correct interpretation, as well as additional clarification using other available techniques, are necessary in modern clinical practice to choose tactics for further therapy.

About the authors

A. A. Vovchenko

A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center, Ministry of Health of Russia

Email: galitsyna.anastaisha@gmail.com
ORCID iD: 0009-0009-6911-3322
Russian Federation, 4 Koroleva St., Obninsk 249031

A. B. Galitsyna

A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center, Ministry of Health of Russia; Obninsk Institute for Nuclear Power Engineering – branch of the National Research Nuclear University MEPHI

Author for correspondence.
Email: galitsyna.anastaisha@gmail.com
ORCID iD: 0009-0009-0188-8420
Russian Federation, 4 Koroleva St., Obninsk 249031; 1 Studgorodok, 249039 Obninsk

A. A. Danilenko

A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center, Ministry of Health of Russia

Email: galitsyna.anastaisha@gmail.com
ORCID iD: 0000-0002-6798-6076
Russian Federation, 4 Koroleva St., Obninsk 249031

N. A. Falaleeva

A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center, Ministry of Health of Russia; Obninsk Institute for Nuclear Power Engineering – branch of the National Research Nuclear University MEPHI

Email: galitsyna.anastaisha@gmail.com
ORCID iD: 0000-0002-0023-4216
Russian Federation, 4 Koroleva St., Obninsk 249031; 1 Studgorodok, 249039 Obninsk

V. A. Shuvaev

A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center, Ministry of Health of Russia; Obninsk Institute for Nuclear Power Engineering – branch of the National Research Nuclear University MEPHI; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia

Email: galitsyna.anastaisha@gmail.com
ORCID iD: 0000-0003-3536-0770
Russian Federation, 4 Koroleva St., Obninsk 249031; 1 Studgorodok, 249039 Obninsk; Build. 1, 2/1 Barrikadnaya St., Moscow 125993

A. Y. Terekhova

A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center, Ministry of Health of Russia; Obninsk Institute for Nuclear Power Engineering – branch of the National Research Nuclear University MEPHI

Email: galitsyna.anastaisha@gmail.com
ORCID iD: 0000-0002-7458-0269
Russian Federation, 4 Koroleva St., Obninsk 249031; 1 Studgorodok, 249039 Obninsk

D. A. Manaenkov

A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center, Ministry of Health of Russia

Email: galitsyna.anastaisha@gmail.com
ORCID iD: 0000-0002-3094-6038
Russian Federation, 4 Koroleva St., Obninsk 249031

S. A. Ivanov

A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center, Ministry of Health of Russia; Obninsk Institute for Nuclear Power Engineering – branch of the National Research Nuclear University MEPHI

Email: galitsyna.anastaisha@gmail.com
ORCID iD: 0000-0001-7689-6032
Russian Federation, 4 Koroleva St., Obninsk 249031; 1 Studgorodok, 249039 Obninsk

A. D. Kaprin

A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center, Ministry of Health of Russia

Email: galitsyna.anastaisha@gmail.com
ORCID iD: 0000-0001-8784-8415
Russian Federation, 4 Koroleva St., Obninsk 249031

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