IntroductionThe malignant lymphomas, Hodgkin disease (HD) and nonHodgkin lymphoma (NHL), comprise approximately 5% to 6% of all malignancies and are the fifth most frequently occurring type of cancer in the United States. In 2007, an estimated 9260 new cases of HD and 81 850 new cases of NHL will be diagnosed in the United States. 1 Once the diagnosis HD or NHL has been established by biopsy of a particular site, determination of disease extent (staging) is important for appropriate treatment planning and determining prognosis. In addition, knowing the sites of involvement at time of diagnosis makes it possible to accurately restage at the end of therapy and document a complete remission. 2,3 Staging of HD and NHL is based on the Ann Arbor classification with the addition of a definition of bulky disease often referred to as the Cotswold modification (Table 1). This staging system encompasses the number of sites of disease involved, the type of involvement (nodal or extranodal), and the distribution of disease. 4 Computed tomography (CT) is currently the most commonly used means for staging patients with malignant lymphoma. 2,3 However, CT lacks functional information, which impedes identification of disease in normal-sized organs. 18 F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) may be an alternative to CT. 5,6 Other promising alternatives to CT are FDG-PET/CT fusion 7,8 and whole-body magnetic resonance imaging (WB-MRI). 9,10 The purpose of this study is to provide an up-to-date overview of the diagnostic performance of CT, FDG-PET, FDG-PET/CT fusion, and WB-MRI in staging of malignant lymphoma.In the first part of this article, technical aspects and procedures of each imaging modality are summarized. Subsequently, we describe our literature search strategy, study selection methods, and study analysis. Next, literature search results and results of analyzed articles are demonstrated. Finally, results are discussed, and advantages, drawbacks, and limitations of each imaging technique are outlined.
Technical aspects and procedures
CTBefore the CT era, patients with a diagnosis of malignant lymphoma were subjected to a battery of radiologic studies that included chest radiography, intravenous pyelography, lymphangiography, skeletal surveys, and isotope scans. On top of this, most patients with HD underwent staging laparotomy with its attendant risks. 11 The introduction of CT in the early 1970s was a tremendous breakthrough in noninvasive imaging, and its potential for staging malignant lymphoma was soon recognized and investigated. 12 Since then, CT has gradually become the imaging modality of choice for staging malignant lymphoma. CT technology has continuously been developed and refined; major milestones include the introduction of spiral CT in the early 1990s and the advent of multidetector-row CT in 1998. The concept of multidetector-row CT deserves special attention; multidetector-row CT scanners have multiple (X) data acquisition systems connected to multidetector arrays to provide a multi...