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A 67-year-old male, 2 years after cadaveric liver transplant for non-alcoholic steatohepatitis cirrhosis and hepatocellular carcinoma developed liver lesions. Biopsy diagnosed Epstein-Barr virus-positive diffuse large B-cell lymphoma. (a) Axial CT images from study performed after seven cycles of chemotherapy showed a residual liver mass (right image, dotted arrow) measuring 3.5 cm in diameter, compared with 4.4-cm diameter at baseline (left image, arrow), indicating only a modest morphological response to therapy. (b) Axial positron emission tomography/CT (PET/CT) images (CT, left; fused, middle; PET, right) after completion of therapy demonstrate no residual abnormal fludeoxyglucose uptake in the residual mass seen on CT, indicating complete metabolic response. On serial surveillance studies, the lesion continued to regress without further intervention, and the patient remained in clinical remission.
Source publication
Post-transplant lymphoproliferative disease (PTLD) is a major cause of morbidity and mortality following both solid organ and hematopoietic stem cell transplantation (HSCT). PTLD has a broad range of manifestations with extranodal involvement more common in the abdomen than nodal involvement. FDG-PET/CT is sensitive and specific to detect PTLD and...
Context in source publication
Citations
... Fluorine-18 fluorodeoxyglucose positron emission tomography/computerized tomography ( 18 F-FDG PET/ CT) has been widely employed in the detection, staging, and assessment of treatment responses in PTLD (22)(23)(24)(25)(26)(27)(28)(29). However, research on the differential diagnostic value of the 18 F-FDG PET/CT metabolic parameters of PTLD and non-PTLD lymphadenopathy in pLT recipients is limited. ...
Background
Post-transplant lymphoproliferative disorder (PTLD) is a significant complication after liver transplantation. Research on the diagnostic value of the Fluorine-18 fluorodeoxyglucose positron emission tomography/computerized tomography (¹⁸F-FDG PET/CT) metabolic parameters of PTLD in pediatric liver transplantation (pLT) recipients is limited. This study sought to evaluate the diagnostic efficacy of ¹⁸F-FDG PET/CT in differentiating between PTLD and non-PTLD lymphadenopathy in pLT recipients.
Methods
This retrospective study collected the ¹⁸F-FDG PET/CT scans with clinical and pathological information of all consecutive children who were clinically suspected of PTLD from November 2016 to September 2022 at the Beijing Friendship Hospital. The ¹⁸F-FDG PET/CT metabolic parameters of the two groups were analyzed. We then established a diagnostic model composed of the clinical characteristics and metabolic parameters.
Results
In total, 57 eligible patients were enrolled in this study, of whom 40 had PTLD and 17 had non-PTLD lymphadenopathy. Of the metabolic parameters examined in this study, total lesion glycolysis (TLG) had the highest area under the curve (AUC) value [0.757, 95% confidence interval (CI): 0.632–0.883, P=0.002]. The AUCs of the other metabolic parameters were all less than the AUC of TLG, including the maximum standardized uptake value (SUVmax) (AUC: 0.725, 95% CI: 0.597–0.853, P=0.008), mean standardized uptake value (SUVmean) (AUC: 0.701, 95% CI: 0.568–0.834, P=0.017), metabolic tumor volume total (MTVtotal) (AUC: 0.688, 95% CI: 0.549–0.827, P=0.040), TLG total (AUC: 0.674, 95% CI: 0.536–0.812, P=0.026). The diagnostic model, which was composed of clinical characteristics (digestive symptoms), the SUVmax, TLG, and the MTVtotal, showed excellent performance in the differential diagnosis (sensitivity: 0.675, 95% CI: 0.508–0.809; specificity: 0.941, 95% CI: 0.692–0.997; positive predictive value: 0.964, 95% CI: 0.798–0.998; and negative predictive value: 0.552, 95% CI: 0.360–0.730).
Conclusions
The ¹⁸F-FDG PET/CT metabolic parameters can be used to distinguishing between PTLD and non-PTLD lymphadenopathy in pLT recipients.
... 18 F-FDG PET/CT imaging has good diagnostic efficacy for patients with suspected PTLD [8,9] and a peak standardized uptake value ≥ 24.8 is strongly suggestive of a monomorphic PTLD subtype [10]. 18 F-FDG PET/CT imaging appears to play an important role in the work-up, staging, and response assessment of patients with PTLD [11]. The diagnosis of PTLD is mainly based on clinical manifestations, imaging examination findings, Epstein-Barr virus load in peripheral blood, and pathological results [12,13]. ...
Posttransplant lymphoproliferative disorder (PTLD) is a serious complication of kidney transplantation, and whole-body 18F- FDG PET/CT imaging plays a key role in patients with PTLD. This article reports three cases of 18F-FDG PET/CT manifestations of gastric, prostate, and pulmonary lymphomas after kidney transplantation, all of which showed local lesions without involvement of adjacent or distant lymph nodes and lymphoid node organs. All patients were treated with a reduced dose of R–CHOP and were generally in a good condition after discharge. Early diagnosis and reasonable treatment are key factors in achieving a better prognosis in patients with PTLD, and whole-body 18F-FDG PET/CT imaging plays an important role in the diagnosis and monitoring of PTLD.
... The median onset of PTLD after transplantation was approximately 6 months in SOT patients and 2-3 months in HSCT recipients. [5] PTLD can be a clonal proliferation of the B-cells or tumors arising from T-cells, natural killer cells, or tumors resembling or indistinguishable from Hodgkin's lymphoma in the posttransplantation setting. PTLD will manifest with lymphadenopathy or mass lesion along with fever, weight loss, and transplant dysfunction. ...
... FDG PET-CT showed a diagnostic accuracy of 89% in assessing PTLD. [5,7,8] Extramedullary AML (E-AML) can occur as a primary lesion or concurrent with a medullary disease or in a relapsed setting. In the relapsed setting, it is more common among patients with HSCT. ...
Tuberculosis (TB) is a common bacterial infection in developing countries. Solid-organ and hematopoietic stem cell transplant recipients are more prone to this infection. Reactivation from previously acquired infection is the most common mode. It has to be ruled out in cases of pyrexia of unknown origin (PUO) before ruling out the other possibilities. We present two cases of incidentally detected TB in the posttransplant patients referred for the evaluation of PUO.
... PTLD lesions display T2 signal hyperintensity compared with that of the psoas muscle (34). PTLD masses are hypermetabolic at PET/CT (36). ...
Posttransplant lymphoproliferative disorder (PTLD) is the most common malignancy that can occur after organ transplant in children. PTLD arises because the patient's immune system has been suppressed to protect the graft and may fail to provide an adequate immune check for transformed malignant or premalignant lymphocytes. PTLD risk factors and pathogenesis are not completely understood; however, Epstein-Barr virus is identified in many patients with PTLD and may contribute to its evolution. PTLD is a clinical challenge because the biologic behavior and clinical manifestations are diverse, and there is no standardized treatment. Treatment options include reduction of immunosuppression therapy, chemotherapy, radiation therapy, and surgical resection of localized lesions, depending on factors including the type and extent of disease, whether the patient has positive test results for the Epstein-Barr virus, and patient comorbidities. A multidisciplinary approach is essential for the appropriate management of PTLD. Diagnostic imaging modalities such as radiography, US, CT, MRI, and PET are essential in diagnosis, assessment of therapeutic response, and monitoring of this heterogeneous disease entity. When imaging findings are suggestive of PTLD, prompt tissue biopsy to identify the PTLD subtype is essential for appropriate treatment. It is important to know the proper indications and limitations of different diagnostic imaging techniques in the management of PTLD. In addition, familiarity with the imaging features of PTLD and its mimics narrows the differential diagnosis and may facilitate decision making about patient treatment. ©RSNA, 2020.
... FDG-PET/CT has become a valuable tool in both staging and monitoring treatment response of PTLD. When undergoing FDG-PET/CT evaluation, upstaging occurs more often than downstaging [31]. The degree of FDG activity in lesions directly correlates with the tumor grade [31]. ...
... When undergoing FDG-PET/CT evaluation, upstaging occurs more often than downstaging [31]. The degree of FDG activity in lesions directly correlates with the tumor grade [31]. A consensus document from the International Conference on Malignant Lymphomas Imaging Working Group defines indications for PET in staging of FDG-avid lymphomas for patient follow-up and evaluation for remission [32]. ...
... A consensus document from the International Conference on Malignant Lymphomas Imaging Working Group defines indications for PET in staging of FDG-avid lymphomas for patient follow-up and evaluation for remission [32]. Initial data of PET/CT in confirming PTLD remission are promising, however must be taken with caution as little prospective data exist [31]. More PTLD lesions are seen with FDG-PET/ CT than diagnostic CT alone, although using both can help with initial staging and guiding biopsy [33]. ...
Purpose
Imaging features of immune-mediated genitourinary diseases often overlap, and the same disease may manifest in different ways, so understanding imaging findings in the context of the patient’s entire clinical picture is important in providing the correct diagnosis.
Methods
In this article, diseases mediated by the immune system which affect the genitourinary system are reviewed. Examples of immune-mediated genitourinary disease including IgG4-related disease, post-transplant lymphoproliferative disorder, immunodeficiency-associated lymphoproliferative disorder due to immunosuppressive and immunomodulatory medications, lymphoma, leukemia, myeloma, amyloidosis, and histiocytosis.
Results
Clinical and imaging features will be presented which may help narrow the differential diagnosis for each disease.
Conclusion
Recognition of immune-related genitourinary disease is important for appropriate medical management as they may mimic other diseases both by imaging and clinical presentation.
... [3] A variety of imaging methods serve different purposes in the diagnosis of PTLD, including ultrasonography (US), contrast-enhanced US (CEUS), [4] computed tomography (CT), magnetic resonance imaging (MRI), contrast-enhanced MRI (CE-MRI), [5] and positron-emission tomography/CT (PET/CT). [6] 2. Case report This study was approved by the institutional review board at the Beijing Friendship Hospital of Capital Medical University, and informed consent was obtained from the patient. ...
... It has been proposed that PET-CT is an accurate diagnostic tool for assessing the disease extent and stage in PTLD patients, and the follow-up treatment response of PTLD (Figs. 14 and 15). [6] Noraini et al [14] suggest further study of the possible relationships between PET-CT findings and PTLD subtypes. The major advantage of PET-CT is high sensitivity with regard to the detection of normal-sized lesions with tumor involvement. ...
Rationale:
Among patients with post-transplant lymphoproliferative disorder (PTLD), there is a high incidence of immunosuppressed transplant recipients. It is necessary to make an early diagnosis to increase the likelihood of a good prognosis.
Patient concerns:
We report a case of a 54-year-old female patient who developed PTLD after liver and kidney transplantation.
Diagnoses:
We aimed to analyze the standard diagnosis and follow-up of PTLD with imaging. Radiologists need to be familiar with all imaging modalities when dealing with PTLD, including ultrasonography, computed tomography, magnetic resonance imaging, positron-emission tomography/computed tomography.
Interventions:
The initial treatment included both reduction of immunosuppression and rituximab. Then the treatment strategy changed to rituximab and chemotherapy. Finally, the treatment strategy combined glucocorticoid therapy.
Outcomes:
The patient was in a stable condition at the 3-month follow-up.
Lessons:
Systematic evaluation of the various imaging modalities, treatment options, and prognoses of PTLD in renal allografts suggested that in cases with a poor prognosis, the proper imaging modalities provide essential information with regard to the determination of the appropriate treatment.
El síndrome linfoproliferativo postrasplante (SLPT o PTLD por sus siglas en inglés, posttransplantation lymphoproliferative disorder) consiste en un grupo heterogéneo de enfermedades linfoproliferativas que ocurren en el marco de la inmunosupresión postrasplante, que pueden abarcar desde una simple hiperplasia linfoidea hasta un linfoma maligno de alto grado, con eventual evolución fatal. Se estima su desarrollo entre el 1 y el 20% de los pacientes trasplantados. Los principales factores asociados con el desarrollo de SLPT son el grado de inmunosupresión y el virus de Epstein Barr (VEB). La mayoría suceden dentro del primer año postrasplante, pero el riesgo de desarrollarlo continúa hasta los 10 años. Su presentación es variable, puede ser asintomático o con manifestaciones inespecíficas (fiebre, linfadenopatías), lo que dificulta su diagnóstico desde el punto de vista clínico. Por este motivo, los métodos de imagen cumplen un rol fundamental en su diagnóstico, siendo la tomografía computada (TC) el más utilizado. Se deberá sospechar desde las imágenes en todo paciente trasplantado con afección nodal, principalmente en retroperitoneo y mesenterio; y/o extranodal, como el tracto gastrointestinal, órganos y el sistema nervioso central. El objetivo del presente trabajo consiste en realizar una revisión sobre el SLPT mediante las imágenes y conocer la importancia de su sospecha y diagnóstico.
Heart transplantation has been increasingly performed for patients with end-stage heart failure most commonly related to ischemic and non-ischemic cardiomyopathies. The major complications are procedure-related complications, infection, acute rejection, cardiac allograft vasculopathy, and malignancy. Radiologists have an important role in the evaluation of transplant candidates and early detection of postoperative complications.
