The role of 18FDG PET/CT in the evaluation of Hodgkin lymphoma

Haema 2012; 3(3): 275-284

by Phivi Rondogianni1 and Ioannis Apostolidis2

1Department of Nuclear Medicine-PET/CT,
2Department of Haematology and Lymphomas and Bone Marrow Transplantation, “Evangelismos” General Hospital, Athens, Greece

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18FDG PET/CT is a noninvasive imaging modality widely used in patients with diverse malignancies, especially those with lymphoma. PET/CT has been evaluated in primary staging, restag- ing after the end of therapy, early estimation of the therapeutic result as well as in post therapy surveillance. The method has been demonstrated to be more sensitive and specific than either 67Ga scintigraphy or computerized tomography in the distinction between scar or fibrosis and active tumor. Data to support these different roles still need validation by even more prospective studies. Moreover caution must be exercised in the interpretation of PET images to avoid false positive and false negative results. Recent attempts to standardize PET interpretation criteria as well as to incorporate it in uniformly adopt- ed response criteria are hopeful for the improvement of lymphoma patients’ outcome. Results of the use of PET during and after completion of therapy for staging of Hodgkin’s lymphoma demonstrate a highly predictive value for outcome but there are problems with the interpretation of results. PET response-adapted therapy is experimental and is the subject of ongoing appropriately designed clinical trials. Clearly, well designed clinical trials are warranted to determine the subsets of patients that will benefit from this modality.