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Lymphomerkrankungen im Kindes- und Jugendalter

Lymphoma in children and adolescents

Zusammenfassung

Klinisches/methodisches Problem

Lymphomerkrankungen sind im Kindesalter die dritthäufigste Neoplasie. Die Erkennung, das exakte Staging und Restaging sind wichtig für alle Radiologen, die mit der Diagnostik von Kindern befasst sind.

Radiologische Standardverfahren

Magnetresonanztomographie (MRT), Positronen-Emissions-Tomographie/Computertomographie (PET/CT), CT, Ultraschall, Röntgen.

Methodische Innovationen

Die Ganzkörperbildgebung (MRT und PET/MRT bzw. PET/CT) spielt in der Diagnostik und für die Therapieauswahl eine zentrale Rolle beim Hodgkin-Lymphom.

Leistungsfähigkeit

Insbesondere die Hybridbildgebung mittels 18F‑FDG-PET erweist sich dabei als leistungsfähige Methode im Staging und Restaging.

Bewertung

Die Standardisierung der Bildgebung und der Einschluss in Therapieoptimierungsstudien (z. B. im Rahmen der EuroNet-PHL-C2-Studie) verbessert die Diagnostik und vermindert gleichzeitig die therapiebedingten Nebenwirkungen.

Empfehlung für die Praxis

Beim Hodgkin-Lymphom (HD) sind Abweichungen vom vorgegebenen Diagnostikprozedere zu vermeiden. Beim klinisch sehr heterogenen Non-Hodgkin-Lymphom (NHL) sollte dagegen die Diagnostik dem aktuellen klinischen Zustand des Kindes angepasst werden. Die Rolle der Interims-PET beim NHL ist derzeit noch Gegenstand klinischer Diskussionen.

Abstract

Clinical/methodological issue

Lymphoma is the third most common neoplasm in children. Detection, accurate staging, and restaging are important for all radiologists involved in the diagnosis of children.

Standard radiological methods

Magnetic resonance imaging (MRI), positron emission tomography/computed tomography (PET/CT), CT, ultrasound, X‑ray.

Methodological innovations

Whole-body imaging (MRI and PET-MRI or PET-CT) play a key role in diagnostics and for therapy selection in Hodgkin lymphoma.

Performance

In particular, hybrid imaging using 18F‑FDG PET is proving to be a powerful method for staging and restaging.

Achievements

Standardization of imaging and inclusion in therapy studies (e.g. within the framework of the EuroNet-PHL-C2 study) improves diagnostics and simultaneously reduces therapy-related side effects.

Practical recommendations

In Hodgkin lymphoma, deviations from the prescribed diagnostic procedure should be avoided. In clinically very heterogeneous non-Hodgkin lymphoma (NHL), on the other hand, the diagnostic procedure should be adapted to the actual clinical condition of the child. The role of interim PET in NHL is currently still the subject of clinical discussion.

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Corresponding author

Correspondence to Ina Sorge.

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Interessenkonflikt

I. Sorge, T.W. Georgi und F.W. Hirsch geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Sorge, I., Georgi, T.W. & Hirsch, F.W. Lymphomerkrankungen im Kindes- und Jugendalter. Radiologe 61, 611–618 (2021). https://doi.org/10.1007/s00117-021-00873-9

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Schlüsselwörter

  • Tumoren im Kindesalter
  • Hodgkin-Lymphom
  • Non-Hodgkin-Lymphom
  • Ganzkörperbildgebung
  • Staging

Keywords

  • Pediatric cancer
  • Hodgkin lymphoma
  • Non-Hodgkin lymphoma
  • Whole body imaging
  • Neoplasm staging