IMAGING IN LYMPHOMA Diagnosis Staging Responce assesment Follow

IMAGING IN LYMPHOMA Diagnosis Staging Responce assesment Follow up

Conventional radiology

Ultrasonography

MRI

Diffusion weighted MRI

whole body DW MRI

MDCT The essential anatomic method

FDG/PET-CT Essential imaging test for staging, treatment planning, and response assessment of many lymphomas

Hybrid PET-CT scanner

2 -[F-18]fluoro-2 -deoxy-dglucose

Differential uptake of FDG

TYPE FDG AVIDITY Hodgkin lymphoma (10% of all lymphomas) Typically high FDG uptake Diffuse large B-cell lymphoma (33% of NHL) Typically high FDG uptake Follicular lymphoma (20% of NHL) Variable (low to moderate FDG uptake) Marginal zone lymphoma (9% of NHL) Variable (none to high FDG uptake) Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma of CLL type (7% of NHL) Variable (low to moderate uptake); high avidity suggests malignant transformation Mantle cell lymphoma (MCL) (7% of NHL) Variable (low to high FDG uptake)

In identifying lymph node involvement: CT SENSITIVITY 88% SPECIFITY 86% PET -CT SENSITIVITY 94% SPECIFITY 100%

For organ involvement: CT SENSITIVITY PET -CT SENSITIVITY 50% 88% SPECIFITY 90% 100%

Lugano Criteria for Response Assessment on CT Complete Response Complete disappearance of radiologic evidence of disease Partial Response Progressive No Disease Response If only a single lesion is present, 50% decrease in the PPD <50% decrease New or from baseline increased adenopathy; Splenic volume increase

The five-point scale of FDG uptake 1 No FDG uptake > background 2 FDG uptake < mediastinum 3 FDG uptake > mediastinum but < liver 4 FDG uptake moderately > liver 5 FDG uptake markedly >>liver and/or new lesions

Lugano Criteria for Response Assessment on PET-CT Complete Response Score of 1, 2, 3 in nodal or extranodal sites Partial Response Progressive No Disease Response Score of 4 or 5 Score 4 or 5 in with no obvious any lesion with reduced uptake change in FDG an increase in compared with uptake intensity of baseline uptake from baseline