FDG-PET Imaging for Hodgkin and Diffuse Large B-Cell Lymphoma-An Updated Overview

Abstract

Since the mid-1990s, ¹⁸F-fluorodeoxglucose (FDG)-positron emission tomography (PET) in combination with computed tomography has come to play a prominent role in the management of malignant lymphomas. One of the first PET applications in oncology was the detection of lymphoma manifestations at staging, where it has shown high sensitivity. Nowadays, this imaging modality is also used during treatment to evaluate the individual chemosensitivity and adapt further therapy accordingly. If the end-of-treatment PET is negative, irradiation in advanced-stage Hodgkin lymphoma patients can be safely omitted after highly effective chemotherapy. Thus far, lymphoma response assessment has mainly been performed using visual criteria, such as the Deauville five-point scale, which became the international standard in 2014. However, novel measures such as metabolic tumor volume or total lesion glycolysis have recently been recognized by several working groups and may further increase the diagnostic and prognostic value of FDG-PET in the future.

Keywords: Hodgkin lymphoma; diffuse large B-cell lymphoma; positron emission tomography; response assessment; staging.

Figure 1

Female diffuse large B-cell lymphoma (DLBCL) patient with multifocal bone marrow involvement at baseline ¹⁸F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) (a), which was missed by undirected bone marrow biopsy and remitted completely after six cycles of chemoimmunotherapy (b).

Figure 2

Metabolic tumor volume (MTV) measurement in a patient with advanced-stage Hodgkin lymphoma based on different thresholding methods. SUV, standardized uptake value; SUV_max, maximum SUV; SUV_mean, mean SUV.