Contrast-enhanced chest and abdominopelvic CT and/or whole-body fluorine 18 fluorodeoxyglucose PET/CT for initial staging, as well as for recurrence of suspected primary central nervous system lymphoma, had a low diagnostic yield.

Primary Central Nervous System Lymphoma: Diagnostic Yield of Whole-Body CT and FDG PET/CT for Initial Systemic Imaging
Chong Hyun Suh, Ho Sung Kim , Ji Eun Park, Seung Chai Jung, Choong Gon Choi, Sang Joon Kim
Author Affiliations
From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul 05505, Republic of Korea.
Address correspondence to H.S.K. (e-mail: radhskim@gmail.com).
Published Online:Jun 25 2019https://doi.org/10.1148/radiol.2019190133
See editorial byHernán Jara
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Abstract
Contrast-enhanced chest and abdominopelvic CT and/or whole-body fluorine 18 fluorodeoxyglucose PET/CT as an initial staging modality for suspected primary central nervous system lymphoma should be carefully considered due to its low diagnostic yield.

Background
Updated guidelines for suspected primary central nervous system lymphoma (PCNSL) are lacking.

Purpose
To investigate the diagnostic yield of initial systemic imaging in patients suspected of having PCNSL by using contrast material–enhanced chest and abdominopelvic CT and/or whole-body fluorine 18 fluorodeoxyglucose (FDG) PET/CT.

Materials and Methods
This retrospective study included 304 patients examined at a single tertiary hospital between January 1998 and October 2018. Consecutive adults (age >18 years) who were confirmed to have newly diagnosed PCNSL on the basis of findings at stereotactic brain biopsy were recruited. All patients were examined with contrast-enhanced chest and abdominopelvic CT and/or whole-body FDG PET/CT before initiation of PCNSL treatment. The diagnostic yield of CT and PET/CT was determined before therapy and at the time of recurrence in the brain. A χ2 test was performed to compare the diagnostic yield according to study date in order to assess for possible changes in technology during the study period.

Results
A total of 304 patients (180 men with a mean age [±standard deviation] of 58 years ± 13 and 124 women with a mean age of 59 years ± 13) were included. The diagnostic yield of CT and PET/CT for initial staging was 2% (six of 304 patients; 95% confidence interval [CI]: 0.7%, 4.3%), and these tests yielded false-positive findings in 13 of the 304 patients (4%; 95% CI: 2.3%, 7.2%). Diagnostic yield did not differ between patients evaluated before 2009 and those evaluated in 2009 and later (P = .82). The diagnostic yield of systemic imaging at recurrence was 1.5% (one of 68 patients; 95% CI: 0.0%, 7.9%), and these tests yielded false-positive findings in four of those 68 patients (6%; 95% CI: 1.6%, 14.4%).

Conclusion
Contrast-enhanced chest and abdominopelvic CT and/or whole-body fluorine 18 fluorodeoxyglucose PET/CT for initial staging, as well as for recurrence of suspected primary central nervous system lymphoma, had a low diagnostic yield.

© RSNA, 2019

See also the editorial by Jara in this issue.

Article History
Received: Jan 17 2019
Revision requested: Mar 8 2019
Revision received: Apr 23 2019
Accepted: Apr 30 2019
Published online: June 25 2019
Published in print: Aug 2019
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