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Abstract
Primary central nervous system lymphoma (PCNSL) typically shows a strong uptake of F-fludeoxyglucose (FDG) imaged by positron emission tomography (PET). Uncommonly, PCNSL demonstrates a low uptake on FDG PET. We investigated the clinicopathological characteristics of the unusual cases of PCNSL with low FDG uptake.We retrospectively enrolled 104 consecutive patients with newly diagnosed PCNSL who underwent baseline brain FDG PET. The degree of FDG uptake of PCNSL was visually scored by 4 grades (0, ≤contralateral white matter; 1, >contralateral white matter and <contralateral gray matter; 2, = contralateral gray matter; 3, >contralateral gray matter). Grades 0-2 were considered as PCNSL with low uptake. We investigated association of low uptake of PCNSL with the following clinicopathological factors: age, sex, steroid treatment, lactate dehydrogenase level, cerebrospinal fluid protein level, condition of PET scanning, immunohistochemical markers (cluster of differentiation 10 [CD10], B-cell lymphoma 6 [BCL-6], B-cell lymphoma 2 [BCL-2], multiple myeloma oncogene 1 [MUM1], Epstein-Barr virus [EBV] protein, and Ki67), location of lesions, tumor size, multiplicity of lesions, involvement of deep brain structures, and cystic or necrotic appearance of lesions.Of the 104 patients with PCNSL, 14 patients (13.5%) showed PCNSL with low FDG uptake on PET. Among various clinicopathological factors, MUM1 negativity was the only factor associated with low FDG uptake PCNSL by univariate (P = .002) and multivariate analysis (P = .007).This study suggests that the different clinicopathological characteristics between patients with high uptake and low uptake of PCNSL on FDG PET is closely associated with lack of MUM1, a protein known to be a crucial regulator of B-cell development and tumorigenesis.

Affiliations

Hye Ok Kim  1 , Jae Seung Kim  2 , Seon-Ok Kim  3 , Sun Young Chae  2 , Seung Jun Oh  2 , Minjung Seo  4 , Suk Hyun Lee  5 , Jungsu S Oh  2 , Jin-Sook Ryu  2 , Joo-Ryung Huh  6 , Jeong Hoon Kim  7
1 Department of Nuclear Medicine, College of Medicine, Ewha Womans University.
2 Department of Nuclear Medicine.
3 Department of Clinical Epidemiology and Biostatistics.
4 Department of Nuclear Medicine, Ulsan University Hospital.
5 Division of Nuclear Medicine, Department of Radiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine.
6 Department of Pathology.
7 Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.