State of the art in oncologic imaging of Lymphoma.

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State of the art in oncologic imaging of Lymphoma.

February 3, 2013 by Dror Nir

State of the art in oncologic imaging of Lymphoma.

Author and Curator: Dror Nir, PhD

This is the last post in a series in which I will address the state of the art in oncologic imaging based on a review paper; Advances in oncologic imaging^†^‡ that provides updates on the latest approaches to imaging of 5 common cancers: breast, lung, prostate, colorectal cancers, and lymphoma. This paper is published at CA Cancer J Clin 2012. © 2012 American Cancer Society.

The paper gives a fair description of the use of imaging in interventional oncology based on literature review of more than 200 peer-reviewed publications. In this post I summaries the chapter on imaging used in management of Lymphoma.

The traditional tasks of imaging in the management of lymphoma include: staging, assessing response to therapy and confirming it reaching an end-point and detecting recurrence. The leading imaging modality is PET/CT. In their literature review the authors include several references claiming that the clinical outcome of lymphoma patients has improved significantly due to better prognosis – largely related to better disease characterization and identification of prognostic markers in recent years. Adoption of functional imaging that improved pre-treatment staging and assessment of the response to treatment contributed as well to this outcome 178 .179 “Most of the recent progress in management of lymphoma occurred after the widespread introduction of [¹⁸F]FDG PET and PET/CT. Accordingly, [¹⁸F]FDG PET is now part of the revised lymphoma response criteria.180 “

A 46-year-old male with diffuse large B cell lymphoma, stage IV was studied. Baseline maximum intensity projection (MIP) positron emission tomography (PET) image with [18F]fluorodeoxyglucose ([18F]FDG) (A) shows widespread disease, which is essentially resolved on interim scan after 4 cycles of chemotherapy (B). The interim scan also shows increased [18F]FDG uptake in bone marrow related to administration of granulocyte colony-stimulating factor (GCSF). (C,D) Transaxial CT and PET/CT fusion images at baseline show abnormal [18F]FDG uptake in extensive mediastinal and hilar lymphadenopathy as well as in bone lesions in a right rib and the right scapula. On interim scan (E,F) abnormal [18F]FDG uptake at all of these sites has resolved although residual enlarged lymph nodes remain. The sites are better seen on a contrast-enhanced CT (G) and measure up to 5.3 cm × 3.6 cm. Chemotherapy was continued for a total of 8 cycles. At the time of writing, the patient remained disease-free after 9 years of follow-up.

Subsequent to their acknowledgment of PET/CT as the most promising imaging modality for management of Lymphoma, the authors focused their review to on its role in this disease pathway. It being well understood that the clinical utility of [¹⁸F]FDG PET in lymphoma “depends on the intensity of radiotracer uptake in disease sites, which will affect the test accuracy for staging and characterizing residual masses after completion of therapy, as well as the role of the test in response assessment. The intensity of [¹⁸F]FDG uptake in lymphoma is determined by tumor histology, grade (eg, indolent versus aggressive NHL)”,181, 182 At the end of their extensive review the authors do mention that PET/MRI might become an important player in the management of this disease, especially in pediatric cases.