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Antibody-positive paraneoplastic neurologic syndromes

Value of CT and PET for tumor diagnosis

From the Departments of Nuclear Medicine (Dr. Linke) and Clinical Radiology (Dr. Helmberger) and Institute for Clinical Neuroimmunology (Dr. Voltz), Klinikum Grosshadern der LMU; Friedrich Baur Institute (Dr. Schroeder), Klinikum Innenstadt der LMU; and Dept. of Neurology (Drs. Schroeder and Voltz), LMU, Munich, Germany.

Address correspondence and reprint requests to Prof. Dr. Raymond Voltz, Institute for Clinical Neuroimmunology, Klinikum Grosshadern, D- 81366 Munich, Germany; e-mail: Raymond.Voltz{at}med.uni-muenchen.de

Objective: To assess use of whole-body ¹⁸F fluoro-2-deoxy-glucose (FDG)-PET and CT for diagnosing tumor in patients with antibody-positive paraneoplastic neurologic syndromes (PNS).

Methods: In order to directly compare CT and FDG-PET imaging in patients with various antineuronal antibodies, the authors performed in parallel CT scanning and FDG-PET in a series of 13 consecutive patients (9 women, 4 men, aged 59 ± 14 years) with positive antineuronal antibodies (anti-Hu: 8, anti-Yo: 4, anti-Tr: 1) in whom the authors were searching for a tumor or tumor recurrence.

Results: A new tumor or tumor recurrence was found in 10/13 patients (5 small cell lung cancer, 2 ovarian cancer, and 1 each neuroblastoma, Hodgkin’s lymphoma, and lymph node metastasis of adenocarcinoma). All tumors except one with good clinical evidence for small cell lung cancer were confirmed histologically. For detection of tumor or tumor recurrence, CT was positive in 3/10 patients (sensitivity of 30%), and FDG-PET in 9/10 (sensitivity of 90%, difference between methods p < 0.01), but the combination of both methods showed a sensitivity of 100%.

Conclusions: FDG-PET imaging is useful in tumor screening of patients with antineuronal antibodies, but should be complemented by CT scanning to increase sensitivity and accuracy of tumor diagnosis.

Received October 21, 2003. Accepted in final form March 16, 2004.

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