FDG-Avid Intrathecal Inflammation Following Administration of Intrathecal Methotrexate.

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FDG-Avid Intrathecal Inflammation Following Administration of Intrathecal Methotrexate.

Clin Nucl Med. 2016 Dec;41(12):995-997

Authors: Hogan MP, Osborne J, Ulaner GA

Abstract
Intrathecal methotrexate is a standard option for central nervous system-directed therapy in patients with stage III and IV diffuse large B-cell lymphoma. We present a case of a 50-year-old man with stage IV diffuse large B-cell lymphoma with widespread lymphomatous involvement including the central nervous system, who received 7 doses of intrathecal methotrexate via Ommaya catheter. Posttherapy F-FDG-PET/CT imaging demonstrated diffuse, intense intrathecal FDG avidity, without correlative findings on MR spinal imaging. FDG avidity resolved on follow-up. These PET/CT findings are most consistent with methotrexate-induced thecal inflammation, which needs to be distinguished from intrathecal malignancy.

PMID: 27805919 [PubMed - indexed for MEDLINE]

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