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The identification of lymph node disease in lymphoma

Department of Clinical Radiology, St James's University Hospital, Leeds LS9 7TF
Academic Department of Diagnostic Radiology, Royal Marsden NHS Trust, Sutton, Surrey SM2 5PT, UK

Summary

• Radiological staging plays a key role in management strategy in Hodgkin's disease (HD).
  
• Lymph node involvement alone is common in HD whereas associated extranodal disease is frequently seen in non-Hodgkin's lymphoma (NHL).
  
• Disease spread in HD is via lymphatic channels to contiguous nodal groups, in NHL spread is haematogenous and therefore non-contiguous.
  
• Cervical and thoracic adenopathy are commoner in HD than NHL; retroperitoneal and mesenteric nodes are more frequently seen at presentation in NHL.
  
• In HD, infradiaphragmatic disease mainly involves portocaval, coeliac axis and splenic hilar groups. Splenic hilar nodes are associated with splenic parenchymal disease.
  
• CT is the primary imaging modality, MRI and ultrasound are used for problem solving, and ultrasound to guide intervention.
  
• Size is the main CT criterion for nodal involvement; lymphangiography is rarely performed in the UK.