Lymphoma: Differential Diagnosis of Mediastinal Masses and Response

  • Dominique Delbeke


Recommendations for the clinical use of [18F]-fluorodeoxyglucose positron emission tomography/computed tomography ([18F]-FDG PET/CT) imaging have become available [1] and the imaging technique has been incorporated into the management algorithms recommended by the National Comprehensive Cancer Center Network (NCCN) [2]. Procedures and practice guidelines have been published by the Society of Nuclear Medicine (SNM) and the American College of Radiology (ACR) [3, 4, 5]. Recommendations in National Cancer Institute (NCI) clinical trials are also available [6]. For patients with lymphoma, consensus recommendations for assessing response have been published by the imaging subcommittee of the International Harmonization Project, including criteria for interpretation [7]. Response criteria for lymphoma have been revised based on PET/CT imaging, eliminating the “complete remission unconfirmed (CRu)” category [8].


Standard Uptake Value Follicular Lymphoma Mantle Cell Lymphoma Autologous Stem Cell Transplant Indolent Lymphoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Podoloff DA, Advani RH, Allred C et al (2007) NCCN Task Force Report: positron emission tomography (PET)/computed tomography (CT) scanning in cancer. J Natl Compr Canc Netw 5(Suppl 1):S1–S22PubMedGoogle Scholar
  2. 2.
    Fletcher JW, Djulbegovic B, Soares HP et al (2008) Recommendations for the Use of FDG (fluorine-18, (2-[18F]fluoro-2-deoxy-D-glucose) positron emission tomography in Oncology. J Nucl Med 49:480–508PubMedCrossRefGoogle Scholar
  3. 3.
    Coleman RE, Delbeke D, Guiberteau MJ et al (2005) Intersociety dialogue on concurrent PET-CT with an integrated imaging system: From the Joint ACR/SNM/SCBT-MR PET-CT Working Group. J Nucl Med 46:1225–1239PubMedGoogle Scholar
  4. 4.
    Delbeke, Coleman RE, Guiberteau MJ et al (2006) Society of Nuclear Medicine procedure guidelines for tumor imaging using FDG PET/CT. J Nucl Med 47:885–895PubMedGoogle Scholar
  5. 5.
    American College of Radiology (2007) ACR practice guidelines for performing FDG PET/CT in oncology.
  6. 6.
    Shankar LK, Hoffman JM, Bacharach S et al (2006) National Cancer Institute. Consensus recommendations for the use of 18F-FDG PET as an indicator of therapeutic response in patients in National Cancer Institute Trials. J Nucl Med 47:1059–1066PubMedGoogle Scholar
  7. 7.
    Juweid ME, Stroobants S, Hoekstra OS et al (2007) Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol 25:571–578PubMedCrossRefGoogle Scholar
  8. 8.
    Cheson BD, Pfistner B, Juweid ME et al (2007) Revised response criteria for malignant lymphoma. J Clin Oncol 25:579–586PubMedCrossRefGoogle Scholar
  9. 9.
    Hutchings M, Loft A, Hansen M et al (2006) Different histopathological subtypes of Hodgkin lymphoma show significantly different levels of FDG uptake. Hematol Oncol 24:146–150PubMedCrossRefGoogle Scholar
  10. 10.
    National Cancer Institute: “Staging”
  11. 11.
    Harris NL, Jaffe ES, Diebold J et al (1999) World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting, Airlie House, Virginia, November 1997. J Clin Oncol 17:3835–3849PubMedGoogle Scholar
  12. 12.
    Ping Lu (2005) Staging and classification of lymphoma. Semin Nucl Med 35:160–164CrossRefGoogle Scholar
  13. 13.
    Schoder H, Noy A, Gonen M et al (2005) Intensity of 18-fluorodeoxyglucose uptake in positron emission tomography distinguishes between indolent and aggressive non-Hodgkin’s lymphoma. J Clin Oncol 23:4643–4651PubMedCrossRefGoogle Scholar
  14. 14.
    Elstrom R, Guan L, Baker G et al (2003) Utility of FDG-PET scanning in lymphoma by WHO classification. Blood 101:3875–3876PubMedCrossRefGoogle Scholar
  15. 15.
    Tsukamoto N, Kojima M, Hasegawa M et al (2007) The usefulness of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) and a comparison of (18)F-FDG-PET with (67)gallium scintigraphy in the evaluation of lymphoma: relation to histologic subtypes based on the World Health Organization classification. Cancer 110:652–659PubMedCrossRefGoogle Scholar
  16. 16.
    Brepoels L, Stroobants S, De Wever W et al (2008) Positron emission tomography in mantle cell lymphoma. Leuk Lymphoma 49:1693–1701PubMedCrossRefGoogle Scholar
  17. 17.
    Kako S, Izutsu K, Ota Y et al (2007) T-cell FDG-PET in T-cell and NK-cell neoplasms. Ann Oncol 18:1685–1690PubMedCrossRefGoogle Scholar
  18. 18.
    Jerusalem G, Beguin Y, Najjar F et al (2001) Positron emission tomography (PET) with 18F-fiuorodeoxyglucose (18F-FDG) for the staging of low-grade non-Hodgkin’s lymphoma (NHL). Ann Oncol 12:825–830PubMedCrossRefGoogle Scholar
  19. 19.
    Bruzzi JF, Macapinlac H, Tsimberidou AM et al (2006) Detection of Richter’s transformation of chronic lymphocytic leukemia by PET/CT. J Nucl Med 47:1267–1273PubMedGoogle Scholar
  20. 20.
    Najjar F, Hustinx R, Jerusalem G et al (2001) Positron emission tomography (PET) for staging low-grade non-Hodgkin’s lymphomas (NHL). Cancer Biother Radiopharm 16:297–304PubMedCrossRefGoogle Scholar
  21. 21.
    Hoffmann M, Kletter K, Becherer A et al (2003) 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) for staging and follow-up of marginal zone B-cell lymphoma. Oncology 64:336–340PubMedCrossRefGoogle Scholar
  22. 22.
    The International Non-Hodgkin’s Lymphoma Prognostic Factors Project (1993) A predictive model for aggressive non-Hodgkin’s lymphoma. N Engl J Med 329:987–994CrossRefGoogle Scholar
  23. 23.
    Solal-Céligny P, Roy P, Colombat P et al (2004) Follicular lymphoma international prognostic index. Blood 104:1258–1265PubMedCrossRefGoogle Scholar
  24. 24.
    Hasenclever D, Diehl V (1998) A prognostic score for advanced Hodgkin’s disease. International Prognostic Factors Project on Advanced Hodgkin’s Disease. N Engl J Med 339:1506–1514PubMedCrossRefGoogle Scholar
  25. 25.
    Okada J, Oonishi H, Yoshikawa K et al (1994) FDG-PET for predicting the prognosis of malignant lymphoma. Ann Nucl Med 8:187–191PubMedCrossRefGoogle Scholar
  26. 26.
    Israel O, Keidar Z, Bar-Shalom R (2004) Positron emission tomography in the evaluation of lymphoma. Semin Nucl Med 34:166–179PubMedCrossRefGoogle Scholar
  27. 27.
    Seam P, Juweid ME, Cheson BD (2007) The role of FDG-PET scans in patients with lymphoma. Blood 110:3507–3516PubMedCrossRefGoogle Scholar
  28. 28.
    Buchmann I, Reinhardt M, Eisner K et al (2001) 2-(fluorine-18)fluoro-2-deoxy-D-glucose positron emission tomography in the detection and staging of malignant lymphoma. A bicenter trial. Cancer 91:889–899PubMedCrossRefGoogle Scholar
  29. 29.
    Isasi CR, Lu P, Blaufox MD (2005) A metaanalysis of 18F-2-deoxy-2-fluoro-D-glucose positron emission tomography in the staging and restaging of patients with lymphoma. Cancer 104:1066–1074PubMedCrossRefGoogle Scholar
  30. 30.
    Thill R, Neuerburg J, Fabry U et al (l 997) Comparison of findings with 18-FDG PET and CT in pretherapeutic staging of malignant lymphoma. Nuklearmedizin 36:234–239Google Scholar
  31. 31.
    Moog F, Bangerter M, Diederichs CG et al (1998) Extranodal malignant lymphoma: detection with FDG PET versus CT. Radiology 206:475–481PubMedGoogle Scholar
  32. 32.
    Moog F, Bangerter M, Kotzerke J et al (1998) 18-F-fluo-rodeoxyglucose-positron emission tomography as a new approach to detect lymphomatous bone marrow. J Clin Oncol 16:603–609PubMedGoogle Scholar
  33. 33.
    Carr R, Barrington SF, Madan B et al (1998) Detection of lymphoma in bone marrow by whole-body positron emission tomography. Blood 91:3340–3346PubMedGoogle Scholar
  34. 34.
    Pakos EE, Fotopoulos AD, Ioannidis JP (2005) 18F-FDG PET for evaluation of bone marrow infiltration in staging of lymphoma: a meta-analysis. J Nucl Med 46:958–963PubMedGoogle Scholar
  35. 35.
    Schaefer NG, Hany TF, Taverna C et al (2004) Non-Hodgkin lymphoma and Hodgkin disease: coregistered FDG PET and CT at staging and restaging — do we need contrast-enhanced CT? Radiology 232:823–829PubMedCrossRefGoogle Scholar
  36. 36.
    Raanani P, Shasha Y, Perry C et al (2006) Is CT scan still necessary for staging in Hodgkin and non-Hodgkin lymphoma patients in the PET/CT era? Ann Oncol 17:117–122PubMedCrossRefGoogle Scholar
  37. 37.
    Rodríguez-Vigil B, Gómez-León N, Pinilla I et al (2006) PET/CT in lymphoma: prospective study of enhanced full-dose PET/CT versus unenhanced low-dose PET/CT. J Nucl Med 47:1643–1648PubMedGoogle Scholar
  38. 38.
    Hicks RJ, MacManus MP, Seymour JF (2005) Initial staging of lymphoma with positron emission tomography and computed tomography. Semin Nucl Med 35:165–175PubMedCrossRefGoogle Scholar
  39. 39.
    Bangerter M, Kotzerke J, Griesshammer M et al (1999) Positron emission tomography with 18-fluorodeoxyglucose in the staging and follow-up of lymphoma in the chest. Acta Oncol 38:799–804PubMedCrossRefGoogle Scholar
  40. 40.
    Cremerius U, Fabry U, Neuerburg J et al (1998) Positron emission tomography with 18F-FDG to detect residual disease after therapy for malignant lymphoma. Nucl Med Commun 19:1055–1063PubMedCrossRefGoogle Scholar
  41. 41.
    Spaepen K, Mortelmans L (2001) Evaluation of treatment response in patients with lymphoma using [18F]FDG-PET: differences between non-Hodgkin’s lymphoma and Hodgkin’s disease. Q J Nucl Med 45:269–273PubMedGoogle Scholar
  42. 42.
    Cheson BD, Horning SJ, Coiffier B (1999) Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas. NCI Sponsored International Working Group. J Clin Oncol 17:1244PubMedGoogle Scholar
  43. 43.
    Juweid ME, Wiseman GA, Vose JM et al (2005) Response assessment of aggressive non-Hodgkin’s lymphoma by integrated International Workshop criteria and fluorine-18-fluorodeoxyglucose positron emission tomography. J Clin Oncol 23:4652–4661PubMedCrossRefGoogle Scholar
  44. 44.
    Jerusalem G, Beguin Y, Fassotte MF et al (1999) Whole-body positron emission tomography using 18F-fluorodeoxyglucose for posttreatment evaluation in Hodgkin’s disease and non-Hodgkin’s lymphoma has higher diagnostic and prognostic value than classical computed tomography scan imaging. Blood 94:429–433PubMedGoogle Scholar
  45. 45.
    Mikhaeel NG, Timothy AR, O’Doherty MJ et al (2000) 18-FDG-PET as a prognostic indicator in the treatment of aggressive Non-Hodgkin’s Lymphoma-comparison with CT. Leuk Lymphoma 39:543–553PubMedCrossRefGoogle Scholar
  46. 46.
    Jerusalem G, Hustinx R, Beguin Y, Fillet G (2005) Evaluation of therapy for lymphoma. Semin Nucl Med 35:186–196PubMedCrossRefGoogle Scholar
  47. 47.
    Terasawa T, Nihashi T, Hotta T, Nagai H (2008) 18F-FDG PET for posttherapy assessment of Hodgkin’s disease and aggressive Non-Hodgkin’s lymphoma: a systematic review. J Nucl Med 49:13–21PubMedCrossRefGoogle Scholar
  48. 48.
    Kelloff GJ, Sullivan DM, Wilson W et al (2007) FDG-PET lymphoma demonstration project invitational workshop. Acad Radiol 14:330–339PubMedCrossRefGoogle Scholar
  49. 49.
    Kazama T, Faria SC, Varavithya V et al (2005) FDG PET in the evaluation of treatment for lymphoma: clinical usefulness and pitfalls. Radiographics 25:191–207PubMedCrossRefGoogle Scholar
  50. 50.
    Abdel-Dayem HM, Rosen G, El-Zeftawy H et al (1999) Fluorine-18 fluorodeoxyglucose splenic uptake from extramedullary hematopoiesis after granulocyte colony-stimulating factor stimulation. Clin Nucl Med 24:319–322PubMedCrossRefGoogle Scholar
  51. 51.
    Gundlapalli S, Ojha B, Mountz JM (2002) Granulocyte colony-stimulating factor: confounding F-18 FDG uptake in outpatient positron emission tomographic facilities for patients receiving ongoing treatment of lymphoma. Clin Nucl Med 27:140–141.PubMedCrossRefGoogle Scholar
  52. 52.
    Ferdinand B, Gupta P, Kramer EL (2004) Spectrum of thymic uptake at 18F-FDG PET. Radiographics 24:1611–1616PubMedCrossRefGoogle Scholar
  53. 53.
    Joyce JM, Degirmenci B, Jacobs S et al (2005) FDG PET CT assessment of treatment response after yttrium-90 ibritumomab tiuxetan radioimmunotherapy. Clin Nucl Med 30: 564–568PubMedCrossRefGoogle Scholar
  54. 54.
    Ulaner GA, Colletti PM, Conti PS (2008) B-cell non-Hodgkin lymphoma: PET/CT evaluation after 90Y-ibritumomab tiuxetan radioimmunotherapy—initial experience. Radiology 246: 895–902PubMedCrossRefGoogle Scholar
  55. 55.
    Zinzani PL, Tani M, Fanti S et al (2008) A phase II trial of CHOP chemotherapy followed by yttrium 90 ibritumomab tiuxetan (Zevalin) for previously untreated elderly diffuse large B-cell lymphoma patients. Ann Oncol 19:769–773PubMedCrossRefGoogle Scholar
  56. 56.
    Johnston PB, Wiseman GA, Micallef IN (2008) Positron emission tomography using F-18 fluorodeoxyglucose pre-and post-autologous stem cell transplant in non-Hodgkin’s lymphoma. Bone Marrow Transplant 41:919–925PubMedCrossRefGoogle Scholar
  57. 57.
    Schot BW, Zijlstra JM, Sluiter WJ et al (2007) Early FDG-PET assessment in combination with clinical risk scores determines prognosis in recurring lymphoma. Blood 109:486–491PubMedCrossRefGoogle Scholar
  58. 58.
    Filmont JE, Gisselbrecht C, Cuenca X (2007) The impact of pre-and post-transplantation positron emission tomography using 18-fluorodeoxyglucose on poor-prognosis lymphoma patients undergoing autologous stem cell transplantation. Cancer 110:1361–1369PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • Dominique Delbeke
    • 1
  1. 1.Department of Radiology and Radiological SciencesVanderbilt University Medical CenterNashvilleUSA

Personalised recommendations