Manifestations of toxic lung effects on Ga-67 scans in aggressive non-Hodgkin's lymphoma with high-dose CHOP chemotherapy

Patients with aggressive non-Hodgkin's lymphoma may benefit from high-dose chemotherapy. This treatment is, however, associated with relatively severe toxic effects. Ga-67 and computed tomography (CT) are used for early restaging and follow-up, and recognition of therapy-related changes on both scans may be essential to prevent interpretation of false-positive images of recurrent disease or infectious complications. These two cases illustrate typical patterns of benign Ga-67 uptake in patients with aggressive non-Hodgkin's lymphoma treated with high-dose chemotherapy. Intense diffuse or centrally distributed abnormal lung uptake on Ga-67 scans was observed in 12% of the authors' patients on midtreatment scans and in 24.% at the end of high-dose CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone) with or without focal, rather symmetric bihilar focal activity. Ga-67 abnormalities correlated with diffuse ground-glass lung parenchymal opacity on high-resolution CT, which showed no abnormality in the hila. Changes related to the toxic effects of treatment resolved spontaneously even with continued therapy during a period of several months.