Contribution of 99mTcSPECT after 18-F-FDG-PET/CT in the follow-up of patients with malignant lymphoma

Full text: Introduction: We present the case of a 29 - year-old woman diagnosed with Hodgkin lymphoma (HL) stage IV in 2002, in the course of follow-up after an extirpation of mediastinal tumor formation (including thymectomy) with involvement of adjacent structures and vascular infiltration supervene on chemotherapy to achieve clinical remission lasting till now. Materials and Methods: Performed CT in 2010 shows thrombosis of the prosthetic right brachiocephalic vein without further developed thrombectomy due to collateral network. For the restaging /confirmation of available clinical remission 18F-FDG-PET/CT has been conducted again and it established an area of increased metabolic activity with a single calcification retrosternal a bit o the right of midline, suspected relapse. Additionally there is a hypometabolic zone in liver without morphological correlate incl. ultrasound. In order to clarify the findings in the mediastinum and taking into account the previously (2006) performed tumorotropic 99mTc-MIBI- scintigraphy with proliferating mediastinal foci, a control SPECT- scintigraphy with 99mTc-TF have been made. Between the two studies there has been no specific therapy. Results: It was found similar to the previous scintigraphy foci of hyperphiction in the mediastinum in topographic area of hypometabolic foci of PET/CT, with no evidence for dynamics. After comparing the findings from the PET/CT both scintigraphic studies, the missing dynamics in them (about 4 years) and clinical remission of the patient is considered most likely that it is a persistent available benign metabolic activity of the residual/hypertrophied thymus tissue or still - inflammatory active fibrotic process in the post-operative changes in the vicinity of existing vascular thrombosis. Conclusion: According to the scintigraphy with 99mTc-TF contribution to the conclusion that at the moment there is no sure evidence for relapse, the patient is referred to long- lasting dynamic control