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(Circulation. 1998;97:2577-2578.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Metabolic Imaging Identifies Non-Hodgkin's Lymphoma Infiltrating Heart

Wolfgang Römer, MD; Manfred Garbrecht, MD; Christoph Fuchs, MD; ; Markus Schwaiger, MD

From the Nuklearmedizinische Klinik rechts der Isar, Technische Universität München, and IV. Medizinische Abteilung, Krankenhaus München Neuperlach, Germany.

Correspondence to Dr Wolfgang Römer, Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany.

A67-year-old man was diagnosed with a lymphoblastic non-Hodgkin's lymphoma and was found to have tumor infiltrating the right atrium, the ventricular septum, and the left ventricle. The tumor was imaged by TEE and MRT, and the diagnosis was confirmed by biopsy. After completion of six courses chemotherapy with CHOEP, no residual wall motion abnormalities or contrast changes were detectable by TEE. A follow-up MRT was not possible after pacemaker implantation became necessary because of AV conduction abnormalities. A CT scan was performed but could not be evaluated because of metal artifacts. A PET scan with FDG was performed to exclude residual tumor mass.

Non-Hodgkin's lymphomas exhibit an enhanced FDG uptake, as do most malignant tumors.¹ In contrast to myocardial tissue, tumor FDG uptake is independent of plasma substrate levels and insulin stimulation, allowing identification of tumor infiltration. Therefore, the patient was fasted >12 hours before the FDG study to minimize glucose uptake in normal myocardium. Before the FDG study, a flow study with [¹³N]ammonia was performed to document myocardial perfusion.

The images (Figure, A) show the ammonia and FDG studies after six courses of CHOEP. The perfusion study demonstrated a homogeneous perfusion of the left ventricle, but the FDG study revealed evidence of viable tumor in the lateral wall of the left ventricle. There was focally enhanced tracer accumulation in the mediastinum representing involved lymph nodes. The FDG uptake was documented as the SUV, which is the maximum radioactivity concentration in a region of interest divided by the . . . [Full Text of this Article]