Hodgkin’s Disease Staging by FDG PET/CT in a Pregnant Woman

Calais, Jérémie; Hapdey, Sébastien; Tilly, Hervé; Véra, Pierre; Chastan, Mathieu

doi:10.1007/s13139-014-0263-7

Cited by 13 publications

(10 citation statements)

References 9 publications

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“…A literature search in MEDLINE for positron emission tomography and pregnancy limited to humans, where dosimetry is available was performed on 13 April 2016. The references from these articles were also reviewed, and in total there was one abstract 6 and eight papers 7–14 where PET scans were performed in pregnancy with dosimetry data published. One of these papers 8 reported on the same patient (with slightly different calculations) as a previous paper 7 ; therefore, 8 publications from 2004 to 2015 describing a total of 19 examinations in 18 pregnant women were reviewed.…”

Section: Discussionmentioning

confidence: 99%

“…Other authors have also found that the results from PET changed the management for their patients. In the paper by Calais et al., 13 a 26-year-old woman at 26 weeks’ gestation with scleronodular Hodgkin’s lymphoma underwent a low-dose PET/CT scan which demonstrated stage IIIA disease. With this information, she was able to receive corticosteroids until delivery at 36 weeks, avoiding potentially being incorrectly staged and the pursuit of more harmful treatment options.…”

Section: Discussionmentioning

confidence: 99%

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The use of PET/CT in pregnancy: A case report of malignant parathyroid carcinoma and a review of the literature

et al. 2017

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Positron emission tomography scanning is not commonly performed in pregnancy but can be done if required. Fetal doses of radiation can be minimized, and our case exemplifies the safe application of positron emission tomography/computed tomography in pregnancy. A 38-year-old woman in her first ongoing pregnancy presented at 28 weeks' gestation with symptomatic hypercalcemia. Given a history of parathyroid carcinoma, recurrence was suspected. Ultrasound and magnetic resonance imaging failed to locate the lesion. However, positron emission tomography/computed tomography identified a culprit supraclavicular lymph node. This was excised under local anesthesia resulting in normalization of parathyroid hormone and calcium levels. A term, healthy baby was delivered. The literature provides support that the use of positron emission tomography/computed tomography is acceptable when indicated, and there are modifications to protocols that can further limit risk.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The use of PET/CT in pregnancy: A case report of malignant parathyroid carcinoma and a review of the literature

et al. 2017

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“…As a consequence, an ever-increasing number of pregnant women are injected with radiopharmaceuticals (2). Fetal radiation exposure may be accidental if the pregnancy is unknown at the time of the PET scan (3)(4)(5)(6) or may be the consequence of a diagnostic workup for cancer in the mother (7)(8)(9). In both cases, knowing the fetal absorbed dose is important for correctly assessing the risk to the fetus and for putting this risk in perspective against the clinical benefit for the mother.…”

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confidence: 99%

Fetal Radiation Dose from ¹⁸F-FDG in Pregnant Patients Imaged with PET, PET/CT, and PET/MR

2015

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The fetal radiation dose from 18 F-FDG was estimated in a series of pregnant women who underwent a PET scan during a clinical workup for malignancies. Methods: Six pregnant patients were injected with 18 F-FDG (activity range, 296-385 MBq). Three patients were scanned during the first trimester (1 with PET and 2 with PET/CT), 2 were scanned during the second trimester (with PET/MR imaging), and 1 was scanned during the third trimester (with PET). The time-integrated activity coefficients were derived from the fetal radioactivity concentrations measured on the images for all but 1 patient (in early pregnancy [5 wk]), in whom the activity in the uterus was used as a proxy. The coefficients of the mother's organs were derived from standard values (from the International Commission on Radiological Protection). Results: Fetal doses ranged from 6.29E-03 to 2.46E-02 mGy/MBq. An earlier bladder voiding reduced these doses by 25%-45%. The 2 patients who underwent PET/MR imaging-in whom fetal contours could be accurately delineated-displayed the lowest fetal absorbed dose, likely because of more accurate region drawing, with the inclusion of areas of both low and high fetal uptake. Moreover, PET/MR imaging did not necessitate additional radiation for attenuation correction. The placenta, delineated on a PET/MR imaging scan, concentrated 0.27% of the injected activity. Conclusion: Fetal radiation doses are higher in early pregnancy than in late pregnancy, and there can be considerable intersubject variability. However, the total absorbed dose is always well below the threshold for noncancer health effects throughout pregnancy. PET/MR imaging is the optimal PET procedure for imaging pregnant women because it is not associated with radiation for attenuation correction and allows more accurate dosimetric calculations.

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“…Abdominal and pelvic CT is associated with an average effective radiation dose of 25 mGy. Few studies have reported fetal radiation exposure during PET‐CT examinations, but these have calculated fetal doses in the range of 1‐21 mGy, which is significantly lower compared to the above‐mentioned adverse fetal effects threshold dose. While the performance of neck and chest CT scan beyond first trimester can be considered reasonable, abdominal‐pelvic CT is usually not recommended, especially up to week 17 of pregnancy …”

Section: Case I: Advanced Stage Newly Diagnosed Hl In the First Trimementioning

confidence: 98%

The management of hodgkin lymphomas in pregnancies

Moshe

Bentur

Lishner

et al. 2017

European J of Haematology

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Hodgkin lymphoma is the most common hematological malignancy in pregnancy. Its management presents several unique challenges, as decisions have to take both maternal and fetal risks into consideration. Using three hypothetical cases, we review current evidence and guidelines and suggest our recommendations for managing pregnant Hodgkin lymphoma patients. The opportunity for a prompt and accurate diagnosis should not be missed; this may be achieved by vigilance to suggestive symptoms, performance of biopsy which is not contraindicated during pregnancy and use of MRI for staging. Most patients should receive treatment with doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) after completion of the first trimester. Bridging therapy with corticosteroids or vinblastine should be considered during the first trimester.In most cases of early disease, the addition of chemotherapy cycles to the treatment plan seems preferable to radiation therapy. Diagnosis at relapse raises unique dilemmas regarding second-line chemotherapeutic regimens and timing of consolidation with high-dose therapy and autologous stem cell transplantation, an approach which is contraindicated during pregnancy. Considering the excellent outcomes of Hodgkin lymphoma outside pregnancy, every effort should be made to strive toward a curative treatment plan while balancing the multiple issues and dilemmas which arise when treating this malignancy in a pregnant patient.

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Hodgkin’s Disease Staging by FDG PET/CT in a Pregnant Woman

Cited by 13 publications

References 9 publications

The use of PET/CT in pregnancy: A case report of malignant parathyroid carcinoma and a review of the literature

The use of PET/CT in pregnancy: A case report of malignant parathyroid carcinoma and a review of the literature

Fetal Radiation Dose from ¹⁸F-FDG in Pregnant Patients Imaged with PET, PET/CT, and PET/MR

The management of hodgkin lymphomas in pregnancies

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Hodgkin’s Disease Staging by FDG PET/CT in a Pregnant Woman

Cited by 13 publications

References 9 publications

The use of PET/CT in pregnancy: A case report of malignant parathyroid carcinoma and a review of the literature

The use of PET/CT in pregnancy: A case report of malignant parathyroid carcinoma and a review of the literature

Fetal Radiation Dose from 18F-FDG in Pregnant Patients Imaged with PET, PET/CT, and PET/MR

The management of hodgkin lymphomas in pregnancies

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Fetal Radiation Dose from ¹⁸F-FDG in Pregnant Patients Imaged with PET, PET/CT, and PET/MR