From the Guidelines
For a patient with lymphoma and subcutaneous involvement on a CT head scan, the recommended imaging modality is whole-body PET/CT as the primary imaging technique, along with MRI of the brain and affected areas. This recommendation is based on the most recent and highest quality study, which emphasizes the importance of PET-CT in staging and response assessment of lymphoma patients 1. The use of PET-CT allows for accurate visualization of metabolic activity in lymphoma cells throughout the body, providing detailed anatomical information that is essential for treatment planning and response assessment.
Some key points to consider when evaluating a patient with lymphoma and subcutaneous involvement on a CT head scan include:
- The importance of PET-CT in staging and response assessment, as it has been shown to improve the accuracy of staging compared to CT scans alone 1
- The use of MRI in evaluating brain involvement, spinal cord compression, or soft tissue extension, as it offers superior soft tissue contrast 1
- The potential role of ultrasound in evaluating superficial lymph nodes or guiding biopsies of subcutaneous lesions, although this is not a primary imaging modality for lymphoma staging 1
In terms of specific imaging modalities, the following are recommended:
- Whole-body PET/CT as the primary imaging technique
- MRI of the brain and affected areas to evaluate for brain involvement, spinal cord compression, or soft tissue extension
- Ultrasound as a secondary imaging modality for evaluating superficial lymph nodes or guiding biopsies of subcutaneous lesions
It is essential to note that the choice of imaging modality will depend on the specific clinical scenario and the patient's individual needs. However, based on the available evidence, whole-body PET/CT is the recommended primary imaging technique for patients with lymphoma and subcutaneous involvement on a CT head scan 1.
From the Research
Imaging Modalities for Lymphoma
For a patient with lymphoma and subcutaneous involvement on a computed tomography (CT) head scan, the following imaging modalities are recommended:
- PET-CT: Functional imaging with 18-F-fluorodeoxyglucose (FDG)-positron emission tomography combined with computed tomography (PET-CT) is widely recognized as the most sensitive and specific imaging modality for patients with lymphoma 2, 3, 4, 5, 6.
- FDG-PET/CT: This modality plays a central role in treatment decisions, including accurate staging, assessing response to therapy, and planning radiation therapy 3, 4, 6.
Specific Uses of PET-CT
PET-CT is useful in:
- Staging disease: Accurately staging disease to guide treatment selection 2, 3, 4, 5, 6.
- Assessing response to therapy: Evaluating response to therapy and predicting prognosis 2, 3, 4, 5, 6.
- Planning radiation therapy: Enabling precise target delineation for radiation therapy planning 3, 4.
- Detecting relapse: Excluding relapse if patients develop clinical features suggestive of disease relapse 4, 5, 6.
Subcutaneous Involvement
For patients with subcutaneous involvement, PET-CT can help identify areas of lymphoma missed by CT alone and avoid under-treatment of patients with advanced disease stage 2, 4.