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Positron emission tomography and CT in the management of lymphoma

Royal Marsden Hospital, London, UK

Summary

• ¹⁸F-FDG-PET/CT is becoming the imaging modality of choice in staging Hodgkin's and high-grade non-Hodgkin's lymphoma, particularly in defining extranodal disease.
  
• Assessment of early response after chemotherapy using 18FDG-PET/CT can provide prognostic information, identifying patients who may relapse within 2 years.
  
• Residual mass assessment with ¹⁸F-FDG-PET/CT has led to the development of more tailor-made treatment strategies.
  
• At present, it is unclear if the additional information provided by ¹⁸F-FDG-PET/CT translates into better outcomes.
  

The introduction of metabolic imaging with ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) has had a major impact on the management of lymphoma. In Hodgkin's and high-grade non-Hodgkin's lymphomas in particular, ¹⁸F-FDG-PET/CT has been shown to be more accurate than conventional CT in radiological staging. It can define malignant lesions in structures that appear normal upon anatomical imaging. ¹⁸F-FDG-PET/CT is far superior to other imaging techniques in defining extranodal disease and in detecting focal bony deposits. Early and end-of-treatment response assessment with ¹⁸F-FDG-PET/CT is also more accurate than other assessments and can provide prognostic information. Residual masses are very common in lymphomas, with a reported incidence of up to 60%, and the assessment of these masses is a particular strength of metabolic imaging. Here, the diagnostic confidence imparted by ¹⁸F-FDG-PET/CT is leading to more tailor-made treatment approaches. These approaches avoid the use of radiotherapy for metabolically inactive lesions and, conversely, allow the early instigation of second-line therapies in patients with persistent disease. At present there is, however, little published evidence that these improvements actually translate into significant survival benefits for the patient. Other, more cancer-specific PET tracers are also currently under investigation. In addition, the ongoing development of whole-body MRI may become particularly valuable in the paediatric population.