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First published online April 20, 2009, 10.2967/jnumed.108.057190
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PET/CT for Therapy Response Assessment in Lymphoma

Martin Hutchings1,2 and Sally F. Barrington3,4

1 Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 2 Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 3 PET Imaging Centre, Kings College London, London, United Kingdom; and 4 Division of Imaging, Guy's and St. Thomas' Foundation NHS Trust, London, United Kingdom


Figure 1
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  		FIGURE 1.  Patient diagnosed with NHL from biopsy of left cervical node. In addition to disease in left neck, 18F-FDG uptake in normally sized lymph nodes in left superior mediastinum and paraaortic nodes below diaphragm (arrows in A) and in right iliac bone (B) was indicative of stage IV rather than stage II disease.

 

Figure 2
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  		FIGURE 2.  (A) At staging, patient with diffuse large B-cell lymphoma had extensive peritoneal and omental disease, which is often difficult to assess with CT. (B) Interim scanning after 2 cycles of chemotherapy showed complete metabolic response.

 

Figure 3
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  		FIGURE 3.  Patient with HL had persistent active disease after 2 cycles of chemotherapy, suggesting poor prognosis. Staging (A) and interim (B) scans are shown.

 

Figure 4
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  		FIGURE 4.  Differences between 2 patients with residual mediastinal masses after treatment. (A) No significant uptake in left anterior mediastinal mass in one patient. (B) Focal uptake in mediastinal mass, suggesting residual tumor, in another patient. Viable lymphoma cells may be contained in large areas of fibrosis, leading to sampling errors at biopsy.

 

Figure 5
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  		FIGURE 5.  Uptake in mediastinum after treatment was attributed to sarcomatoid reaction on biopsy. Patient remains clinically well 2 y from this scan.

 




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