Beyond PET/CT in Hodgkin lymphoma: a comprehensive review of the role of imaging at initial presentation, during follow-up and for assessment of treatment-related complications

Abstract

ObjectiveThe purpose of this article is to provide a comprehensive review of the role of imaging modalities other than PET/CT in the management of Hodgkin lymphoma (HL). PET/CT is the imaging modality of choice in the management of Hodgkin’s lymphoma (HL). However, imaging modalities other than PET/CT such as plain radiographs, ultrasound, CT, MRI and nuclear imaging can help in various stages of clinical management of HL, including the initial workup and post-treatment surveillance. Both CT and MRI help in detecting recurrences, treatment-related pulmonary, cardiovascular and abdominal complications as well as second malignancies. Familiarity with expected post-treatment changes and complications on surveillance images can help radiologists guide patient management. The purpose of this article is to provide a comprehensive review of the role of imaging modalities other than PET/CT in the management of Hodgkin lymphoma (HL).Main Messages• Surveillance of HL patients is usually performed with plain radiographs and CT.• Follow-up imaging can depict normal post-treatment changes or treatment-related complications.• Imaging is important for the timely detection of second malignancies in HL patients.

Musculoskeletal Imaging Findings of Hematologic Malignancies

“…Use of FDG PET/CT often upstages both Hodgkin lymphoma and NHL compared with conventional CT (40,44,45). Both Hodgkin lymphoma and NHL cells are 18 F-FDG avid (46). In general, lymphoma is 18 F-FDG avid: a study of 766 patients found that overall 94% of all lymphomas were 18 F-FDG avid; notable exceptions were peripheral T-cell lymphoma (90%), small lymphocytic lymphoma (83%), enteropathy-type T-cell lymphoma (67%), splenic marginal zone lymphoma (67%), mucosaassociated lymphoid tissue (MALT) marginal zone lymphoma (54%), lymphomatoid papulosis (50%), and primary cutaneous anaplastic large T-cell lymphoma (40%) (47).…”

Pigmented villonodular synovitis mimics metastases on fluorine 18 fluorodeoxyglucose position emission tomography-computed tomography

“…Despite the increased use of position emission tomography-computed tomography (PET-CT), its role in surveillance imaging remains under debate (1,2). PET-CT imaging is superior to CT alone in detecting active disease and therefore plays a major role in determining response to therapy.…”

Thoracic Imaging Manifestations of Treated Lymphomas

“…Calcifications in untreated lymphoma are very rare, occurring in <1% of patients, and are associated with aggressive subtypes of Uptake markedly ( > 2-3×) higher than liver and/or new lesions X New areas of uptake unlikely related to lymphoma HL. 30 Dystrophic nodal calcifications may develop in 2% to 8% of patients treated with radiation or chemotherapy (Fig. 10).…”

“…These carry a cause-specific mortality of ~10%. 30 Complications may be acute or chronic and include pericarditis, cardiomyopathy, heart failure, coronary artery disease, and valvular heart disease (Fig. 11).…”

“…Radiation-induced pulmonary toxicity is generally limited to the tissues directly exposed to the radiation field, and the degree of damage is related to the total radiation dose, fractionation, dose rate, beam arrangement, and volume of involved lung tissue. 30 Radiation pneumonitis occurs within 4 to 12 weeks following therapy manifesting as an organizing pneumonia pattern on CT including groundglass opacities, irregular nodular consolidation, and atelectasis within the radiation field (Fig. 12).…”