Advertisement

Computerised tomography in the staging of Hodgkin's disease and non-Hodgkin's lymphoma

  • Sarah J. VinnicombeEmail author
  • Rodney H. Reznek
Article

Abstract

The last 25 years have seen major changes in the imaging investigation and subsequent management of patients with Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL); accurate staging is vital for prognostication and treatment in both, and particularly in HD. The choice of imaging modality for staging depends on its accuracy, impact on clinical decision-making, and availability. Modern CT scanners fulfil most of the desired criteria. The advent of CT scanning, along with the development of ever more effective chemotherapeutic regimens, has resulted in the virtual demise of bipedal lymphangiography (LAG) as a staging tool in patients with lymphoma. It has rendered superfluous a battery of other tests that were in routine use. This contribution reviews the evidence for the use of CT in preference to LAG. CT accurately depicts nodal enlargement above and below the diaphragm, has variable sensitivity for intra-abdominal visceral involvement and is generally outstanding in depicting the extent of disease, especially extranodal extension. Despite the advances in CT technology, there are still areas where CT performs less well (e.g. disease in normal-sized lymph nodes, splenic and bone marrow infiltration). The influence of technical factors, such as the use of intravenous contrast medium, is discussed. In some instances, CT is not the imaging modality of choice and the place of newer techniques such as MRI and endoscopic ultrasound will be reviewed.

Keywords

Computerised tomography Hodgkin's disease Non-Hodgkin's lymphoma Staging Lymphangiography 

References

  1. 1.
    Lister TA, Crowther D, Sutcliffe SB, et al. Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin's disease: the Cotswold meeting. J Clin Oncol 1989; 7:1630–1636.Google Scholar
  2. 2.
    Mackenzie R, Dixon AK. Measuring the effects of imaging: an evaluative framework. Clin Radiol 1995; 50:513–518.Google Scholar
  3. 3.
    Fineberg HV, Bauman R, Sosman M. Computerised cranial tomography: effect on diagnostic and therapeutic plans. J Am Med Assoc 1977; 238:224–227.Google Scholar
  4. 4.
    Goldin J, Sayre JW. A guide to clinical epidemiology for radiologists. Part II. Statistical analysis. Clin Radiol 1996; 51:317–324.Google Scholar
  5. 5.
    Kelsey Fry I. Who needs high technology? Br J Radiol 1984; 57: 765–772Google Scholar
  6. 6.
    Fineberg HV, Wittenberg J, Ferrucci JT et al. The clinical value of body computed tomography over time and technologic change. Am J Roentgenol 1983; 141:1067–1072.Google Scholar
  7. 7.
    Modic MT. Outcomes research, appropriateness and pragmatism in neurologic MR imaging. J Magn Reson Imaging 1994; 4:26.Google Scholar
  8. 8.
    Kreel L. Computerised tomography using the EMI general purpose scanner. Br J Radiol 1977; 50:2–14.Google Scholar
  9. 9.
    Kreel L. The EMI whole body scanner in the demonstration of lymph node enlargement. Clin Radiol 1976; 27:421–429.Google Scholar
  10. 10.
    Schaner EG, Head GL, Doppman JL, Young RC. Computed tomography in the diagnosis, staging and management of abdominal lymphoma. J Comput Assist Tomogr 1977; 1:176–180.Google Scholar
  11. 11.
    Redman HC, Glatstein E, Castellino RA, Federal WA. Computed tomography as an adjunct in the staging of Hodgkin's disease and non-Hodgkin's lymphomas. Radiology 1977; 124:381–385.Google Scholar
  12. 12.
    Alcorn FS, Mategrano VC, Petasnick JP, Clark JW. Contributions of computed tomography in the staging and management of malignant lymphoma. Radiology 1977; 125:717–723.Google Scholar
  13. 13.
    Breiman RS, Castellino RA, Harell GS, et al. CT-pathologic correlations in Hodgkin's disease and non-Hodgkin's lymphoma. Radiology 1978; 126:159–166.Google Scholar
  14. 14.
    Jones SE, Tobias DA, Waldman RS. Computed tomographic scanning in patients with lymphoma. Cancer 1978; 41:480–486.Google Scholar
  15. 15.
    Best JK, Blackledge G, Forbes WS, et al. Computed tomography of abdomen in staging and clinical management of lymphoma. Br Med J 1978; 2:1675–1677.Google Scholar
  16. 16.
    Lee JKT, Stanley RJ, Sagel SS, Levitt RG. Accuracy of computed tomography in detecting intraabdominal and pelvic adenopathy in lymphoma. Am J Roentgenol 1978; 131:311–315.Google Scholar
  17. 17.
    Earl HE, Sutcliffe SB, Kelsey Fry I, et al. Computerised tomographic (CT) abdominal scanning in Hodgkin's disease. Clin Radiol 1980; 31:149–153.Google Scholar
  18. 18.
    Castellino RA, Hoppe RT, Blank N, et al. Computed tomography, lymphography and staging laparotomy: correlations in initial staging of Hodgkin's disease. Am J Roentgenol 1984; 143:37–41.Google Scholar
  19. 19.
    Enig B, Jensen BB, Madsen EH et al. Detection of neoplastic lymph nodes in Hodgkin's disease and non-Hodgkin lymphoma. Acta Radiol 1985; 24:491–495.Google Scholar
  20. 20.
    Strijk SP. Lymphography and abdominal computed tomography in the staging of non-Hodgkin lymphoma. Acta Radiol 1987; 28:263–269.Google Scholar
  21. 21.
    Pond GD, Castellino RA, Horning S, Hoppe RT. Non-Hodgkin lymphoma: influence of lymphography, CT and bone marrow biopsy on staging and management. Radiology 1989; 170:159–164.Google Scholar
  22. 22.
    Marglin S, Castellino RA. Lymphographic accuracy in 632 consecutive previously untreated cases of Hodgkin disease and non-Hodgkin lymphoma. Radiology 1981; 140:351–353.Google Scholar
  23. 23.
    Tart RP, Mukherji SK, Avino AJ, et al. Facial lymph nodes: normal and abnormal CT appearance. Radiology 1993; 188:695–700.Google Scholar
  24. 24.
    van der Brekel MWM, Stel HV, Castelijns JA, et al. Cervical lymph node metastasis: assessment of radiological criteria. Radiology 1990; 177:379–384.Google Scholar
  25. 25.
    Glazer GM, Gross BH, Quint LE, et al. Normal mediastinal lymph nodes: number and size according to American Thoracic Society mapping. Am J Roentgenol 1985; 144:261–265.Google Scholar
  26. 26.
    Dorfmann RE, Alpern MB, Gross BH, Sandler MA. Upper abdominal lymph nodes: criteria for normal size determined with CT. Radiology 1991; 180:319–322.Google Scholar
  27. 27.
    Callen PW, Korobkin M, Isherwood I. CT evaluation of the retrocrural, prevertebral space. Am J Roentgenol 1977; 129:907–910.Google Scholar
  28. 28.
    Vinnicombe S, Norman A, Husband JE, et al. Normal pelvic lymph nodes: documentation by CT scanning after bipedal lymphangiography. Radiology 1995; 194:349–355.Google Scholar
  29. 29.
    Neumann CH, Robert NJ, Canellos G, Rosenthal D. Computed tomography of the abdomen and pelvis in non-Hodgkin lymphoma. J Comput Assist Tomog 1983; 7:846–850.Google Scholar
  30. 30.
    Shiels PA, Stone J, Ash DV, et al. Priorities for computed tomography and lymphography in the staging and initial management of Hodgkin's disease. Clin Radiol 1984; 35:447–449.Google Scholar
  31. 31.
    Strijk SP, Boetes C, Rosenbusch G, Ruijs J. Lymphography and abdominal computed tomography in staging Hodgkin's disease. Fortschr Röntgenstr 1987; 146:312–318.Google Scholar
  32. 32.
    Libson E, Polliack A, Bloom RA. Value of lymphangiography in the staging of Hodgkin lymphoma. Radiology 1994; 193:757–759.Google Scholar
  33. 33.
    Stomper PC, Cholewinski SP, Park J, Bakshi SP. Abdominal staging of thoracic Hodgkin disease: CT–Lymphangiography–Ga67 scanning correlation. Radiology 1993; 187:381–386.Google Scholar
  34. 34.
    Moskovic E, Fernando I, Blake P, Parsons C. Lymphography—current role in oncology. Br J Radiol 1991; 64:422–427.Google Scholar
  35. 35.
    Pombo F, Rodriguez E, Caruncho MV, et al. CT attenuation values and enhancing characteristics of thoracoabdominal lymphomatous adenopathies. J Comput Assist Tomogr 1994; 18:59–62.Google Scholar
  36. 36.
    Hopper KD, Diehl LF, Cole BA, et al. The significance of necrotic mediastinal lymph nodes on CT in patients with newly diagnosed Hodgkin disease. Am J Roentgenol 1990; 155:267–270.Google Scholar
  37. 37.
    Apter S, Avigdor A, Gayer G, et al. Calcification in lymphoma occurring before therapy: CT features and clinical correlation. Am J Roentgenol 2002; 178:935–938.Google Scholar
  38. 38.
    Rodriguez M, Rehn SM, Nyman RS, et al. CT in malignancy grading and prognostic prediction of non Hodgkin's lymphoma. Acta Radiol 1999; 40:191–197.Google Scholar
  39. 39.
    Munker R, Stengel A, Stäbler A, et al. Diagnostic accuracy of ultrasound and computed tomography in the staging of Hodgkin's disease. Cancer 1995; 76:1460–1466.Google Scholar
  40. 40.
    Clouse ME, Harrison DA, Grassi CJ, et al. Lymphangiography, ultrasonography and computed tomography in Hodgkin's disease and non Hodgkin's lymphoma. J Comput Assist Tomogr 1985; 9:1–8.Google Scholar
  41. 41.
    Magnusson A, Erikson B, Hemmingsson A. Investigation of retroperitoneal lymph nodes in Hodgkin's disease. Upsala J Med Sci 1984; 89:205–212.Google Scholar
  42. 42.
    Neumann CH, Robert RJ, Rosenthal D, Canellos G. Clinical value of ultrasonography for the management of non-Hodgkin lymphoma patients as compared with abdominal computed tomography. J Comput Assist Tomogr 1983; 7:666–669.Google Scholar
  43. 43.
    Nyman R, Rehn S, Ericsson A, et al. An attempt to characterise malignant lymphoma in spleen, liver and lymph nodes with magnetic resonance imaging. Acta Radiol 1987; 28:527–533.Google Scholar
  44. 44.
    Dooms GC, Hricak H, Crooks LE, et al. Magnetic resonance imaging of the lymph nodes: comparison with CT. Radiology 1984; 153:719–728.Google Scholar
  45. 45.
    Lee JKT, Heiken JP, Ling D, et al. Magnetic resonance imaging of abdominal and pelvic lymphadenopathy. Radiology 1984; 153:181–188.Google Scholar
  46. 46.
    Greco A, Jeliffe AM, Maher JE, Leung AWL. MR imaging of lymphomas: impact on therapy. J Comput Assist Tomogr 1988; 19:785–791.Google Scholar
  47. 47.
    Weissleder R, Elizondo G, Wittenberg J, et al. Ultrasmall superparamagnetic iron oxide: an intravenous contrast agent for assessing lymph nodes with MR imaging. Radiology 1990; 175:494–498.Google Scholar
  48. 48.
    Vassallo P, Matei C, Heston WD, et al. AMI-227-enhanced MR lymphangiography: usefulness for differentiating reactive from tumor-bearing lymph nodes. Radiology 1994; 193:501–506.Google Scholar
  49. 49.
    Bellin MF, Roy C, Kinkel K, et al. Lymph node metastases: safety and effectiveness of MR imaging with ultrasmall superparamagnetic iron oxide particles—initial clinical experience. Radiology 1999; 207:799–808.Google Scholar
  50. 50.
    Jochelson MS, Balikian JP, Mauch P, et al. Peri- and paracardiac involvement in lymphoma in a radiographic study of 11 cases. Am J Roentgenol 1983; 140:483–488.Google Scholar
  51. 51.
    Grossman H, Winchester PH, Bragg DG, et al. Roentgenographic changes in childhood Hodgkin's disease. Am J Roentgenol 1970; 108:354–364.Google Scholar
  52. 52.
    North LB, Fuller LM, Hagemeister FB, et al. Importance of initial mediastinal adenopathy in Hodgkin disease. Am J Roentgenol 1982; 138:229–235.Google Scholar
  53. 53.
    Gallagher CJ, White FE, Tucker AK, et al. The role of computed tomography in the detection of intrathoracic lymphoma. Br J Cancer 1984; 49:621–629.Google Scholar
  54. 54.
    Khoury MB, Godwin JD, Halvorsen R, et al. Role of chest CT in non-Hodgkin lymphoma. Radiology 1986; 158:659–662.Google Scholar
  55. 55.
    Hopper KD, Maj MD, Diehl LF, et al. Hodgkin disease: clinical utility of CT in initial staging and management. Radiology 1988; 169:17–22.Google Scholar
  56. 56.
    Castellino RA, Blank N, Hoppe RT, Cho C. Hodgkin disease: contributions of chest CT in the initial staging evaluation. Radiology 1986; 160:603–605.Google Scholar
  57. 57.
    Castellino RA, Hilton S, O'Brien J, Portlock CS. Non-Hodgkin lymphoma: contribution of chest CT in the initial staging evaluation. Radiology 1996; 199:129–132.Google Scholar
  58. 58.
    Shipp M, Harrington D, Anderson J, et al. Development of a predictive model for aggressive lymphoma: the International NHL Prognostic Factors Project. N Engl J Med 1993; 329:987–994.Google Scholar
  59. 59.
    Kadin ME, Glatstein EJ, Dorfman RE. Clinicopathologic studies in 117 untreated patients subject to laparotomy for the staging of Hodgkin's disease. Cancer 1977; 27:1277–1294.Google Scholar
  60. 60.
    Castellino RA, Goffinet DR, Blank N, et al. The role of radiography in the staging of non-Hodgkin's lymphoma with laparotomy correlation. Radiology 1974; 110:329–338.Google Scholar
  61. 61.
    Castellino RA, Marglin S, Blank N. Hodgkin's disease, the non-Hodgkin's lymphomas and the leukaemias in the retroperitoneum. Semin Roentgenol 1980; 15:288–301.Google Scholar
  62. 62.
    Blackledge G, Best JKK, Crowther D, Isherwood I. Computed tomography (CT) in the staging of patients with Hodgkin's disease: a report on 136 patients. Clin Radiol 1980; 31:143–147.Google Scholar
  63. 63.
    Jonsson K, Karp W, Landberg T, et al. Radiologic evaluation of subdiaphragmatic spread of Hodgkin's disease. Acta Radiol 1983; 24:153–159.Google Scholar
  64. 64.
    Breiman RS, Beck JW, Korobkin M, et al. Volume determinations using computed tomography. Am J Roentgenol 1982; 138:329–333.Google Scholar
  65. 65.
    Strijk SP, Wagener DJ, Bogman NJ, et al. The spleen in Hodgkin's disease. Diagnostic value of CT. Radiology 1985; 154:753–757.Google Scholar
  66. 66.
    Strijk SP, Boetes C, Bogman MJ, et al. The spleen in non-Hodgkin's lymphoma. Diagnostic value of CT. Acta Radiol 1987; 28:139–144.Google Scholar
  67. 67.
    Hess CF, Kurtz B, Hoffmann W, Bamberg M. Ultrasound diagnosis of splenic lymphoma: ROC analysis of multidimensional splenic indices. Br J Radiol 1993; 66:859–864.Google Scholar
  68. 68.
    Daskalogiannaki M, Prassopoulos P, Katrinakis G, et al. Splenic involvement in lymphomas: evaluation on serial CT examinations. Acta Radiol 2001; 42:326–332.Google Scholar
  69. 69.
    Carroll BA. Ultrasound of lymphoma. Semin Ultrasound 1982; 111:114–122.Google Scholar
  70. 70.
    Weissleder R, Hahn PF, Stark DD, et al. Superparamagnetic iron oxide: enhanced detection of focal splenic tumours with MR imaging. Radiology 1988; 169:399–403.Google Scholar
  71. 71.
    Weissleder R, Elizondo G, Stark DD, et al. The diagnosis of splenic lymphoma by MR imaging: value of superparamagnetic iron oxide. Am J Roentgenol 1989; 152:175–180.Google Scholar
  72. 72.
    Weinreb JC, Brateman L, Maravilla KR. Magnetic resonance imaging of hepatic lymphoma. Am J Roentgenol 1984; 143:1211–1214.Google Scholar
  73. 73.
    Richards MA, Webb JAW, Reznek RH, et al. Detection of spread of malignant lymphoma to the liver at low field strength magnetic resonance imaging. Br Med J 1986; 293:1126–1128.Google Scholar
  74. 74.
    Stark DD, Weissleder R, Elizondo G, et al. Superparamagnetic iron oxide: clinical application as a contrast agent for MR imaging of the liver. Radiology 1988; 168:297–301.Google Scholar
  75. 75.
    Weissleder R, Stark DD, Elizondo G, et al. MRI of hepatic lymphoma. J Magn Reson Imaging 1988; 6:675–681.Google Scholar
  76. 76.
    Kaplan HS. Essentials of staging and management of the malignant lymphomas. Semin Roentgenol 1980; 15:219–226.Google Scholar
  77. 77.
    Döhner H, Gückel F, Knauf W, et al. Magnetic resonance imaging of bone marrow in lymphoproliferative disorders: correlation with bone marrow biopsy. Br J Haematol 1989; 73:12–17.Google Scholar
  78. 78.
    Shields AF, Porter BA, Churchley S, et al. The detection of bone marrow involvement by lymphoma using magnetic resonance imaging. J Clin Oncol 1987; 5:225–230.Google Scholar
  79. 79.
    Linden A, Zankovitch R, Theissen P, et al. Malignant lymphoma: bone marrow imaging versus biopsy. Radiology 1994; 193:757–759.Google Scholar
  80. 80.
    Hoane BR, Shields AF, Porter BA, et al. Comparison of initial lymphoma staging using computed tomography (CT) and magnetic resonance imaging. Am J Haematol 1994; 47:100–105.Google Scholar
  81. 81.
    Tsunoda S, Takagi S, Tanaka O, et al. Clinical and prognostic significance of femoral marrow magnetic resonance imaging in patients with malignant lymphoma. Blood 1997; 89:286–290.Google Scholar
  82. 82.
    Altehoefer C, Blum U, Bathman J, et al. Comparative diagnostic accuracy of magnetic resonance imaging and immunoscintigraphy for detection of bone marrow involvement in patients with malignant lymphoma. J Clin Oncol 1997; 15:1754–1760.Google Scholar
  83. 83.
    Takagi S, Tsunoda S, Tanaka O. Bone marrow involvement in lymphoma: the importance of marrow magnetic resonance imaging. Leuk Lymph 1998; 29:515–522.Google Scholar
  84. 84.
    Bergin CJ, Healy MV, Zincone GE, Castellino RA. MR evaluation of chest wall involvement in malignanat lymphoma. J Comput Assist Tomogr 1990; 14:928–932.Google Scholar
  85. 85.
    Carlsen SE, Bergin CJ, Hoppe RT. MR imaging to detect chest wall and pleural involvement in patients with lymphoma: effect on radiotherapy planning. Am J Roentgenol 1993; 160:1191–1195.Google Scholar
  86. 86.
    Tesoro-Tess JD, Biasi S, Balzarini L, et al. Heart involvement in lymphomas. The value of magnetic resonance imaging and 2D echocardiography at disease presentation. Cancer 1993; 72:2484–2490.Google Scholar
  87. 87.
    Meyer JE, Kopans DB, Long JC. Mammographic appearance of malignant lymphoma of the breast. Radiology 1980; 135:623–626.Google Scholar
  88. 88.
    Liberman L, Giess CS, Dershaw DD, Louie DC. Non-Hodgkin lymphoma of the breast: imaging characteristics and correlation with histopathological findings. Radiology 1994; 192:157–160.Google Scholar
  89. 89.
    Dodd GD. Lymphoma of the hollow abdominal viscera. Radiol Clin North Am 1990; 28:771–783.Google Scholar
  90. 90.
    Megibow AJ, Balthazar EJ, Naidich DP, et al. Computed tomography of gastrointestinal lymphoma. Am J Roentgenol 1983; 141:541–543.Google Scholar
  91. 91.
    Kessar P, Norton A, Rohatiner AZ, et al. CT appearances of mucosa-associated lymphoid tissue (MALT) lymphoma. Eur Radiol 1999; 9:693–696.Google Scholar
  92. 92.
    Fujishima H, Chijiiwa Y. Endoscopic ultrasound staging of primary gastric lymphoma. Abdom Imaging 1996; 21:192–194.Google Scholar
  93. 93.
    Raderer M, Vorbeck F, Formanek M, et al. Importance of extensive staging in patients with mucosa-associated lymphoid tissue (MALT)-type lymphoma. Br J Cancer 2000; 83:454–457.Google Scholar
  94. 94.
    Yeoman LJ, Mason MD, Olliff JFC. Non-Hodgkin's lymphoma of the bladder—CT and MRI appearances. Clin Radiol 1991; 44:389–392.Google Scholar
  95. 95.
    Jenkins N, Husband JE, Sellars N, Gore M. MRI in primary non-Hodgkin's lymphoma of the vagina associated with a uterine congenital anomaly. Br J Radiol 1997; 70:219–222.Google Scholar
  96. 96.
    Glazer HS, Lee JK, Balfe DM, et al. Non-Hodgkin lymphoma: computed tomographic demonstration of unusual extranodal involvement. Radiology 1983; 149:211–217.Google Scholar
  97. 97.
    Thurnher S, Hricak H, Carroll PR, et al. Imaging the testis: comparison between MR imaging and ultrasound. Radiology 1988; 167:631–636.Google Scholar
  98. 98.
    Zimmerman RA. Central nervous system lymphoma. Radiol Clin North Am 1990; 28:697–721.Google Scholar
  99. 99.
    Chamberlain MC, Sandy AD, Press GA. Leptomeningeal metatstasis: a comparison of gadolinium-enhanced MR and contrast-enhanced CT of the brain. Neurology 1990; 40:435–438.Google Scholar
  100. 100.
    Yousem DM, Patrone PM, Grossman RI. Leptomeningeal metastases: MR evaluation. J Comput Assist Tomogr 1990; 14:255–261.Google Scholar
  101. 101.
    MacVicar D, Williams MP. CT scanning in epidural lymphoma. Clin Radiol 1991; 43:95–102.Google Scholar
  102. 102.
    Stroszczynski C, Oellinger J, Hosten N, et al. Staging and monitoring of malignant lymphoma of the bone: comparison of67Ga scintigraphy and MRI. J Nucl Med 1999; 40:387–393.Google Scholar
  103. 103.
    Hopper KD, Kasales CJ, Van Slyke MA. Analysis of interobserver and intraobserver variability in CT tumour measurements. Am J Roentgenol 1996; 167:851–854.Google Scholar
  104. 104.
    Johnson RJ, Husband JE. Lymphoma. In: The use of CT in the initial investigation of common malignancies. Royal College of Radiologists, 1994.Google Scholar
  105. 105.
    Naik KS, Spencer JA, Craven CM, et al. Staging lymphoma with CT: comparison of contiguous and alternate 10 mm slice techniques. Clin Radiol 1998; 53:523–527.Google Scholar
  106. 106.
    Aisen MA, Gross BH, Glazer GM, Amendola MA. Distribution of abdominal and pelvic Hodgkin disease: implications for CT scanning. J Comput Assist Tomogr 1985; 9:463–465.Google Scholar
  107. 107.
    Dugdale PE, Miles KA, Bunce I, et al. CT measurement of perfusion and permeability within lymphoma masses and its ability to assess grade, activity and chemotherapeutic response. J Comput Assist Tomogr 1999; 23:540–547.Google Scholar
  108. 108.
    Wahl RL, Quint LE, Cieslak RD, et al. "Anatometabolic" tumour imaging: fusion of FDG PET with CT or MRI to localize foci of increased activity. J Nucl Med 1993; 34:1190–1197.Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Department of Diagnostic ImagingSt Bartholomew's HospitalWest Smithfield, LondonUK

Personalised recommendations