18 F-fluorodeoxyglucose positron emission tomography-computed tomography in the management of adult multisystem Langerhans cell histiocytosis

• Published in: European journal of nuclear medicine and molecular imaging Vol. 44; no. 4; p. 598
• Main Authors: Obert, Julie, Vercellino, Laetitia, Van Der Gucht, Axel, de Margerie-Mellon, Constance, Bugnet, Emmanuelle, Chevret, Sylvie, Lorillon, Gwenaël, Tazi, Abdellatif
• Format: Journal Article
• Language: English
• Published: Germany 01.04.2017
• Subjects: Adolescent; Adult; Female; Fluorodeoxyglucose F18; Histiocytosis, Langerhans-Cell - diagnostic imaging; Humans; Lung - diagnostic imaging; Male; Middle Aged; Pituitary Gland - diagnostic imaging; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Thyroid Gland - diagnostic imaging; Langerhans cell histiocytosis; PET-CT; Response to treatment; Management
• ISSN: 1619-7089

The standard evaluation of multisystem Langerhans cell histiocytosis (LCH) includes a clinical evaluation, laboratory tests and a skeleton/skull X-ray survey, with chest high-resolution computed tomography (HRCT) in the case of pulmonary involvement. Preliminary reports suggest that F-fluorodeoxyglucose positron emission tomography-computed tomography ( F-FDG PET-CT) may be useful for evaluating patients with LCH. Fourteen consecutive adult patients with multisystem LCH were included in this retrospective study, and were evaluated using standard procedures and F-FDG PET-CT. The two sets of findings were compared both at baseline and during follow-up. Serial HRCT and pulmonary function tests were used to evaluate outcome in patients with lung involvement. At the baseline evaluation, PET-CT identified every LCH localization found with the standard evaluation (except a mild cecum infiltration). PET-CT showed additional lesions in seven patients, mostly involving bones, and differentiated inactive from active lesions. Thyroid F-FDG uptake was identified in three cases. No pituitary stalk F-FDG uptake was observed in patients with pituitary LCH. Only 3/12 (25 %) patients with pulmonary LCH displayed moderate pulmonary F-FDG uptake. During follow-up, variations (≥50 % of maximum standardized uptake) in bone F-FDG uptake intensity were correlated with disease state and response to treatment. The absence of lung F-FDG uptake did not preclude lung function improvement after treatment. Except for cases with pulmonary and pituitary involvement, F-FDG PET-CT could replace the standard evaluation for staging of adult patients with multisystem LCH. Serial PET-CT scans are useful for evaluating treatment responses, particularly in cases with bone LCH involvement.