Recent studies have not only shown better prognosis of lymphoma with the advancement of therapeutic drug development, but also suggested more attention should be paid to drug-induced lung injury. Early diagnosis is critical for treatment of drug-induced lung injury. 18F-FDG-PET/CT, the standard imaging method for prognosis evaluation of Hodgkin's lymphoma and some non-Hodgkin's lymphoma, has also shown the potential for early detection of drug-induced lung injury in our study. A total of 579 lymphoma patients evaluated by 18F-FDG-PET/CT between June 2016 and March 2018 are studied retrospectively. Clinical and imaging characteristics are described in 32 patients (average age of 55), who were diagnosed with drug-induced lung injury. The incidence of drug-induced lung injury was 5.53% (32/579); most of the chemotherapy regimens include rituximab (90.63%, 29/32). Twelve patients demonstrated fever, cough, and dyspnea, and the other 20 had no significant symptoms. 18F-FDG-PET/CT showed multiple or diffused distribution of ground glass and patchy shadows, with increased FDG uptake in both lungs (SUVmax 2.28 ± 1.13, standardized uptake ratio-blood pool, SUR-BP = 0.59-4.07, median SUR-BP 1.32). SUVmax and SUR-BP in patients with symptoms (SUVmax 3.03 ± 1.33 and SUR-BP 2.12 ± 1.06) were significantly higher than in those without symptoms (SUVmax 1.84 ± 0.70 and SUR-BP 1.18 ± 0.48) (P = 0.002 for both SUVmax and SUR-BP). After temporary drug withdrawal, changing chemotherapy regimens, and corticosteroid usage, the pulmonary lesions in all patients were relieved, confirmed with chest CT. Drug-induced lung injury can be a co-finding during 18F-FDG-PET/CT assessment of lymphoma. With positive correlation between FDG uptake and symptoms, 18F-FDG-PET/CT provided value in early detection of lung injury in asymptomatic patients.
Keywords: 18F-FDG-PET/CT; Drug-induced lung injury; Early detection; Lymphoma.