Leithner Doris, Neri Emanuele, D'Anastasi Melvin, Schlemmer Heinz-Peter, Winkelmann Michael, Kunz Wolfgang G, Cyran Clemens C, Cioni Dania, Sala Evis, Mayerhoefer Marius E
Department of Radiology, NYU Grossman School of Medicine, New York, USA.
Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Pisa, Italy.
Eur Radiol. 2025 Jan 2. doi: 10.1007/s00330-024-11213-5.
Imaging is used for lymphoma detection, Ann Arbor/Lugano staging, and treatment response assessment. [F]FDG PET/CT should be used for most lymphomas, including Hodgkin lymphoma, aggressive/high-grade Non-Hodgkin lymphomas (NHL) such as diffuse large B-cell lymphoma, and many indolent/low-grade NHLs such as follicular lymphoma. Apart from these routinely FDG-avid lymphomas, some indolent NHLs, such as marginal zone lymphoma, are variably FDG-avid; here, [F]FDG PET/CT is an alternative to contrast-enhanced CT at baseline and may be used for treatment response assessment if the lymphoma was FDG-avid at baseline. Only small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) should exclusively undergo CT at baseline and follow-up unless transformation to high-grade lymphoma is suspected. While [F]FDG PET/CT is sufficient to rule out bone marrow involvement in Hodgkin lymphoma, biopsy may be needed in other lymphomas. The 5-point (Deauville) score for [F]FDG PET that uses the liver and blood pool uptake as references should be used to assess treatment response in all FDG-avid lymphomas; post-treatment FDG uptake ≤ liver uptake is considered complete response. In all other lymphomas, CT should be used to determine changes in lesion size; for complete response, resolution of all extranodal manifestations, and for lymph nodes, long-axis decrease to ≤ 1.5 cm are required. KEY POINTS: [F]FDG-PET/CT and contrast-enhanced CT are used to stage lymphoma depending on type. Imaging is required for staging, and biopsies may be required to rule out bone marrow involvement. For treatment response assessment, the 5-PS (Deauville) score should be used; in a few indolent types, CT is used to determine changes in lesion size.
影像学用于淋巴瘤的检测、Ann Arbor/Lugano分期及治疗反应评估。[F]FDG PET/CT应用于大多数淋巴瘤，包括霍奇金淋巴瘤、侵袭性/高级别非霍奇金淋巴瘤（NHL），如弥漫性大B细胞淋巴瘤，以及许多惰性/低级别NHL，如滤泡性淋巴瘤。除了这些常规摄取[F]FDG的淋巴瘤外，一些惰性NHL，如边缘区淋巴瘤，对[F]FDG的摄取情况不一；在此情况下，[F]FDG PET/CT在基线时可作为增强CT的替代检查，若淋巴瘤在基线时摄取[F]FDG，则可用于治疗反应评估。仅小淋巴细胞淋巴瘤/慢性淋巴细胞白血病（SLL/CLL）在基线及随访时应仅行CT检查，除非怀疑已转化为高级别淋巴瘤。虽然[F]FDG PET/CT足以排除霍奇金淋巴瘤的骨髓受累，但其他淋巴瘤可能需要活检。应用肝脏和血池摄取作为参考的[F]FDG PET的5分（Deauville）评分应被用于评估所有摄取[F]FDG淋巴瘤的治疗反应；治疗后FDG摄取≤肝脏摄取被视为完全缓解。在所有其他淋巴瘤中，应使用CT来确定病变大小的变化；对于完全缓解，所有结外表现均应消失，对于淋巴结，其长径应缩小至≤1.5 cm。要点：[F]FDG-PET/CT和增强CT根据淋巴瘤类型用于分期。分期需要影像学检查，可能需要活检以排除骨髓受累。对于治疗反应评估，应使用5分制（Deauville）评分；在少数惰性类型中，使用CT来确定病变大小的变化。
