Imaging for Staging and Response Assessment in Lymphoma

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.50
Procedures: 1.50
Head, Spine, and Musculoskeletal: 0.50
Neck and Chest: 0.50
Abdomen and Pelvis: 0.50

Magnetic Resonance Imaging: 1.75
Patient Care: 0.25
Patient Interactions and Management: 0.25
Procedures: 1.50
Body: 1.00
Musculoskeletal: 0.50

Nuclear Medicine Technology: 1.50
Procedures: 1.50
Endocrine and Oncology Procedures: 1.50

Registered Radiologist Assistant: 1.50
Procedures: 1.50
Neurological, Vascular, and Lymphatic Sections: 1.50

Outline

1. Introduction
2. Lymphoma Staging
3. US, CT, and MR Imaging in Lymphoma
4. The Evolving Role of PET Imaging in Lymphoma
5. Lymphoma Treatment
   1. Hodgkin Lymphoma
   2. Non-Hodgkin Lymphoma
6. Response Assessment
   1. Staging and Response Assessment: Historical Development
   2. The Lugano Classification
   3. Additional Recommendations in the Lugano Classification
   4. Quantification of Treatment Response with FDG PET/CT
7. Discussion of New Response Criteria
8. Interim Imaging
9. Imaging after Completion of Treatment
10. Conclusion

Objectives

Upon completion of this course, students will:

1. identify known risk factors for lymphoma
2. identify viruses that have been linked to lymphoma development
3. understand the stages of the Ann Arbor staging system
4. identify the staging system used to stage primary cutaneous lymphoma
5. list the body components assessed by the TNMB staging system
6. describe the lymphoma subtype that accounts for 10% of all lymphomas
7. describe the lymphoma subtype that accounts for 33% of non-Hodgkin lymphomas
8. list the lymphoma subtype that typically demonstrates high FDG uptake on PET/CT scans
9. describe the characteristics of pulmonary lymphoma
10. list the lymphoma subtypes that commonly demonstrate splenic involvement
11. describe the observations that strongly suggest splenic involvement with lymphoma
12. identify the abdominal organs that are rarely associated with primary lymphoma
13. identify the gastrointestinal structures that are rarely involved with lymphoma
14. indicate the region of the small bowel where lymphoma commonly occurs
15. describe the characteristics of primary lymphoma of bone
16. list the imaging findings that are classified as nonmeasurable disease
17. describe common sites of extranodal involvement of non-Hodgkin lymphoma
18. identify the primary imaging modality for CNS evaluation in lymphoma
19. describe the percentage of non-Hodgkin lymphoma cases represented by CNS lymphoma
20. compare the imaging findings of CNS lymphoma and other CNS disease processes
21. define the role of FDG PET/CT in the evaluation of lymphoma
22. describe the percentage reduction in maximum SUV on FDG PET/CT that indicates satisfactory therapeutic response
23. compare the sensitivity and specificity of FDG PET/CT with those of contrast-enhanced CT in identifying lymph node and organ involvement
24. identify the medication in the R-CHOP chemotherapy regimen that can cause a flare response and lead to a false-positive FDG PET/CT scan
25. list the chemotherapy agents that are part of the ABVD regimen
26. list the chemotherapy agents that are part of the BEACOPP regimen
27. identify the common type of aggressive non-Hodgkin lymphoma that R-CHOP is used to cure
28. list the chemotherapy agents that are administered consecutively with R-CHOP for the treatment of bulky disease
29. describe the timeline of the Cotswolds modifications to the Ann Arbor staging system
30. list the response assessment systems that define clinical response based on FDG avidity of lesions on PET/CT
31. describe the CT image findings that correspond to the different response assessment categories
32. describe the PET/CT image findings that correspond to the different response assessment categories
33. define the size criteria of bulky disease in Hodgkin lymphoma
34. identify the evaluation process that provides the earliest evidence of recurrent disease
35. describe the usefulness of surveillance FDG PET/CT scans after the completion of treatment