Case Author(s): Jeff Chesnut, D.O. and Farrokh Dedashti, M.D. , 6/9/99 . Rating: #D1, #Q5

Diagnosis: Hodgkin's Lymphoma

Brief history:

40 year old male.


Coronal images from an F-18 FDG PET scan are shown.

View main image(pt) in a separate image viewer

View second image(pt). Selected coronal, axial, and sagittal views are shown

View third image(ct). Transaxial slice from CT scan through the pelvis is shown

View fourth image(ct). Another CT slice through the pelvis is shown.

Full history/Diagnosis is available below

Diagnosis: Hodgkin's Lymphoma

Full history:

40 year old male with nodular sclerosing Hodgkin's lymphoma. PET study was requested for staging.


F-18 Flourodeoxyglucose (FDG)


There is extensive, intense increased metabolic activity in several nodal chains including the anterior and posterior cervical chains, bilateral supraclavicular nodes, bilateral axillary nodes, paratracheal, bilateral hilar, retroperitoneal, iliac chain, and bilateral inguinal nodes. There is also focal activity consistent with nodal disease involving the splenic hilum, mesenteric, and peripancreatic region, as well as the gastrohepatic ligament. These all correspond with enlarged nodes seen on outside CT, two slices of which are reproduced here.

There are several foci of increased activity involving the ribs and costovertebral junctions at several levels suggesting bone involvement. There is also heterogenous increased activity involving the spine, most prominent at S1, L4 and L5, and T9 through T11. There is also bone marrow involvement of the entire pelvis, most prominent in the right iliac wing and the region of the right sacroiliac joint. There is also increased activity in the proximal right femur. There is diffuse, heterogenously increased F-18 FDG activity in the entire spleen.


FDG-PET has a very high sensitivity (62% to 100%) in the detection and staging of lymphoma, both Hodgkin's disease and Non-Hodgkin's. At our institution, FDG-PET is rapidly supplanting/replacing Ga-67 scintigraphy as the staging method of choice in lymphoma. Whereas about half of lymphomas are gallium avid, nearly all lymphomas accumulate FDG. In addition, FDG-PET has been shown to be highly accurate in differentiating recurrent/residual tumor from scar. There is also evidence that FDG uptake shortly after institution of therapy is predictive of response.

In the first half of 1999, the Health Care Financing Administration agreed to reimburse F-18 FDG PET for the staging of Hodgkin's and non-Hodgkin's lymphoma.

Reference: 1. Clinical Positron Imaging 1998; 1:101-110.


The patient received high dose chemotherapy.

Major teaching point(s):

1. F-18 FDG is very sensitive and specific for the staging of both Hodgkin's and non-Hodgkin's lymphoma.

2. While only about half of all lymphomas are gallium avid, nearly all lymphomas accumulate F-18 FDG.

ACR Codes and Keywords:

References and General Discussion of PET Tumor Imaging Studies (Anatomic field:Vascular and Lymphatic Systems, Category:Neoplasm, Neoplastic-like condition)

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Case number: pt023

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