Benign thymic enlargement in adults after chemotherapy: CT demonstration.

Kissin, C; Husband, Janet E.; Nicholas, D.; Eversman, William G.

doi:10.1148/radiology.163.1.3823458

Cited by 109 publications

(58 citation statements)

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“…This percentage was slightly higher than the previously reported range of 11%-25% thymic enlargement demonstrated on CT (14,16) and similar to the 11%-36% reported for 67 Ga uptake (17)(18)(19). This incidence is, however, lower than the previously reported 31%-50% for 18 F-FDG PET, most probably because previous studies included mainly children and adolescents, with none or few young adult patients (2,10,15,20).…”

Section: Discussionsupporting

confidence: 76%

Physiologic Thymic Uptake of ¹⁸F-FDG in Children and Young Adults: A PET/CT Evaluation of Incidence, Patterns, and Relationship to Treatment

Jerushalmi¹,

Frenkel²,

Bar‐Shalom³

et al. 2009

J Nucl Med

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18 F-FDG uptake in the thymus, mainly related to hyperplasia after chemotherapy, has been described. Thymic uptake can challenge the accurate assessment of cancer patients by 18 F-FDG imaging. The present study defines the incidence, patterns, and intensity of thymic 18 F-FDG uptake in relationship to age and time after treatment in a large cohort of patients. Methods: A total of 559 consecutive 18 F-FDG PET/CT studies in 160 patients (86 men, 74 women; age, 3-40 y) performed at baseline, during treatment, at the end of treatment, and during follow-up were retrospectively reviewed. PET/CT studies were assessed for the presence or absence (T1 or T2, respectively), pattern, and intensity (SUVmax) of increased 18 F-FDG uptake in the anterior mediastinum, localized by the CT component to the thymus. The overall incidence of 18 F-FDG avidity in the thymus in relationship to the patient's age and time after treatment administration were statistically evaluated. Results: There were 137 of 559 T1 studies (25%), with equal sex distribution. T1 studies were found in significantly younger patients (20.6 6 9.3 y vs. 27.4 6 8.4 y, P , 0.001). Most T1 patients (60%) showed an inverted V pattern of thymic uptake, with additional unilateral mediastinal extension in 24% and focal midline uptake in 16% of studies. T1 studies were encountered in 80% of patients younger than 10 y, compared with 8% of patients in the 31-to 40-y age group. There were 17% T1 studies at baseline, 6% during treatment, 8% at the end of treatment, and 27%-40% during follow-up. The average SUVmax of thymic 18 F-FDG uptake was 3.73 6 1.22. Conclusion: Thymic 18 F-FDG uptake was found in 28% of the present study population, more frequently after treatment. T1 patients were significantly younger. Thymic uptake was found in 73% of untreated patients up to the age of 13 y and in 8% of patients in the fourth decade of life. Knowledge of this age-and treatmentrelated incidence of physiologic thymic 18 F-FDG avidity can reduce the number of potential pitfalls in reporting PET/CT studies in cancer patients.

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Section: Discussionsupporting

confidence: 76%

Physiologic Thymic Uptake of ¹⁸F-FDG in Children and Young Adults: A PET/CT Evaluation of Incidence, Patterns, and Relationship to Treatment

Jerushalmi¹,

Frenkel²,

Bar‐Shalom³

et al. 2009

J Nucl Med

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“…This possibility is underscored by the observation that most infected individuals with a CD4 count in the range of 300-500 cells/l have a high thymic index (scores of 3-4). In the same manner that thymic rebound has been observed in adults after myeloablation (62)(63)(64)(65)(66)(67) and after correction of Cushing's disease (68,69), the peripheral T cell depletion induced by HIV-1 may drive renewed thymocyte maturation in an otherwise dormant thymic remnant. Thymic rebound may contribute to host compensation during the early phase of HIV-1 infection, characterized by maintenance of total T cell counts (70).…”

Section: Cd62lmentioning

confidence: 62%

High prevalence of thymic tissue in adults with human immunodeficiency virus-1 infection.

McCune¹,

Loftus²,

Schmidt³

et al. 1998

J. Clin. Invest.

244

149

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The thymus in adults infected with the HIV-1 is generally thought to be inactive, both because of age-related involution and viral destruction. We have revisited the question of thymic function in adults, using chest-computed tomography (CT) to measure thymic tissue in HIV-1-seropositive ( n ϭ 99) or HIV-1-seronegative ( n ϭ 32) subjects, and correlating these results with the level of circulating CD4 ϩ and CD8 ϩ T cells that are phenotypically described as naive thymic emigrants. Abundant thymic tissue was detectable in many (47/99) HIV-1-seropositive adults, aged 20-59. Independent of age, radiographic demonstration of thymic tissue was significantly associated with both a higher CD4 ϩ T cell count ( P ϭ 0.02) and a higher percentage and absolute number of circulating naive (CD45RA ϩ CD62L ϩ ) CD4 ϩ T cells ( P Ͻ 0.04). The prevalence of an abundant thymus was especially high in younger HIV-1-seropositive adults ( Յ 39 yr) with CD4 counts in the range 300-500 cells/ l and in older subjects ( Ͼ 40 yr) regardless of CD4 count ( P ϭ 0.03). These studies suggest that the thymus is functional in some but not all adults with HIV-1 disease. ( J. Clin. Invest. 1998.

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“…Chest computerized tomograms (CT) have been used to identify thymus tissue in vivo in adults (18)(19)(20) and in the analysis of thymopoiesis in adults with HIV-1 infection (21). In patient no.…”

Section: Analysis Of Thymus Tissue In Patients Who Died With Complicamentioning

confidence: 99%

Analysis of the adult thymus in reconstitution of T lymphocytes in HIV-1 infection

Haynes¹,

Hale²,

Weinhold³

et al. 1999

J. Clin. Invest.

170

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Benign thymic enlargement in adults after chemotherapy: CT demonstration.

Cited by 109 publications

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Physiologic Thymic Uptake of ¹⁸F-FDG in Children and Young Adults: A PET/CT Evaluation of Incidence, Patterns, and Relationship to Treatment

Physiologic Thymic Uptake of ¹⁸F-FDG in Children and Young Adults: A PET/CT Evaluation of Incidence, Patterns, and Relationship to Treatment

High prevalence of thymic tissue in adults with human immunodeficiency virus-1 infection.

Analysis of the adult thymus in reconstitution of T lymphocytes in HIV-1 infection

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Benign thymic enlargement in adults after chemotherapy: CT demonstration.

Cited by 109 publications

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Physiologic Thymic Uptake of 18F-FDG in Children and Young Adults: A PET/CT Evaluation of Incidence, Patterns, and Relationship to Treatment

Physiologic Thymic Uptake of 18F-FDG in Children and Young Adults: A PET/CT Evaluation of Incidence, Patterns, and Relationship to Treatment

High prevalence of thymic tissue in adults with human immunodeficiency virus-1 infection.

Analysis of the adult thymus in reconstitution of T lymphocytes in HIV-1 infection

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Physiologic Thymic Uptake of ¹⁸F-FDG in Children and Young Adults: A PET/CT Evaluation of Incidence, Patterns, and Relationship to Treatment

Physiologic Thymic Uptake of ¹⁸F-FDG in Children and Young Adults: A PET/CT Evaluation of Incidence, Patterns, and Relationship to Treatment