Functional imaging in lymphoma

Whole-body imaging—at least from cervical to inguinal region—of patients with lymphoma is essential to accurately stage nodal and extranodal involvement. At diagnosis, the spatial extent of the disease and the bulk of the tumor is crucial for the choice of the treatment modalities for patients with either Hodgkin or non-Hodgkin lymphoma. Although diagnostic contrast-enhanced CT is still the main imaging modality for posttreatment follow-up, functional biomarker imaging—the integrated FDG-PET/CT—is now included both at initial staging and for the response assessment at the treatment completion in the international recommendations, as well as during the therapy in the clinical trial settings. For initial staging and the evaluation of treatment response, the advantages and the limitations of PET/CT and the emerging whole-body diffusion MR imaging with ADC mapping are analyzed in view of recent publications. The so-called hybrid imaging combining different biomarkers and modalities already brings useful information in order to improve clinical management of lymphoma patients compared to diagnostic CT alone. Functional imaging also allows better understanding of lymphoma diseases and has the potential to tailor individual patient treatments.