adominalmanifestationofextronodallymphomapdf

useonly;allrightsreservedAbdominalImaging•PictorialEssayLeeetal.AbdominalManifestationsofLymphomaAbdominalImagingPictorialEssayAbdominalManifestationsofExtranodalLymphoma:SpectrumofImagingFindingsCopyrightARRS.ForpersonalWai-KitLee1EddieW.F.Lau2VinayA.Duddalwar3AnthonyJ.Stanley4YvonneY.Ho4LeeWK,LauEWF,DuddalwarVA,StanleyAJ,HoYYOBJECTIVE.Thepurposeofthisarticleistoillustratethespectrumofappearancesofextranodallymphomaintheabdomenusingcross-sectionalimagingtechniques.CONCLUSION.Extranodallymphomaintheabdomencanmimicotherneoplasticorinflammatoryconditions.Althoughadefinitivediagnosisispossibleonlywithbiopsy,itisimportanttoconsiderextranodallymphomainthepresenceofcertainimagingappearancesintheappropriateclinicalsettingforthecorrectdiagnosis,accuratestaging,andoptimalmanagement.Downloadedfrom:abdomen,CT,extranodallymphoma,PET/CT,sonographyDOI:10.2214/AJR.07.3146ReceivedSeptember12,2007;acceptedafterrevisionJanuary27,2008.1DepartmentofMedicalImaging,St.Vincent’sHospital,UniversityofMelbourne,41VictoriaParade,Fitzroy,Victoria3065,Australia.AddresscorrespondencetoW.K.Lee([e-mail]).2DepartmentofRadiology,CentreforMolecularImaging,PeterMacCallumCancerCentre,UniversityofMelbourne,EastMelbourne,Victoria3002,Australia.3DepartmentofRadiology,NorrisComprehensiveCancerCenter,UniversityofSouthernCalifornia,LosAngeles,CA.4DepartmentofDiagnosticImaging,TheNationalUniversityHospitalofSingapore,NationalUniversityofSingapore,Singapore.CMEThisarticleisavailableforCMEcredit.See:198–2060361–803X/08/1911–198©AmericanRoentgenRaySocietyxtranodallymphomaoccursinEabout40%ofpatientswithlym­phomaandhasbeendescribed­invirtuallyeveryorganandtissue[1].Indecreasingorderoffrequency,thespleen,liver,gastrointestinaltract,pancreas,abdominalwall,genitourinarytract,adrenal,peritonealcavity,andbiliarytractareinvolved[2–5].Extranodaldiseaseismorecommonwithnon-Hodgkin’slymphoma(NHL)thanwithHodgkin’slymphomaandisoftenintermediate-tohigh-grade[2,3].AIDS-relatedlymphomaandposttrans­plant­­ationlymphoproliferativedisorder­(PTLD)aremorelikelytoaffectextranodal­sitesandareofhighergrade[2,4,5].DiffuselargeB-celllymphomaandfollicularlymphomaarethedominanthistologicsubtypes­inextranodallymphoma.Mantlecelllymph­oma,lymphoblastic­lymphoma,Burkitt’slymphoma,andmucosa-associatedlymphoidtissue(MALT)lymphoma,however,aremorelikelytoaffectextranodalsites[2].MALTlymphomaisalow-grademarginalzoneB-celllymphomathatismostcommonlyfoundinthestomach.Itiscloselyassociatedwithchronicinflammation,suchasHelico­bacterpylorigastritis,andhasaclinicallyindolentcourse.Secondaryinvolvement­ofextranodaltissuesaspartofgeneralizedlymphomaissignificantly­morecommonthanprimaryextranodal­disease,inwhichthereisadominantextranodalcomponentwithnoorminornodalinvolve­ment­.Splenic,hepatic,ordiffuseinvolvementofoneormoreextranodalorgansindicatesamoreadvanc­edstageofdisease.Extranodalinvolvement­isingeneralapoorprognosticfactor.Theproteanimagingappearancesofex-tranodallymphomaintheabdomencanmimicotherneoplasticorinflammatoryconditions­.Misinterpretationoftheimagingfindingscanleadtodelayeddiagnosisandtreatment,andincorrectstagingmayresultininappropriatetreatment.Inthisarticle,weillustratetheappearancesofextranodallym-phomaintheabdomenofimmunocompetent­andimmunocompromisedpatientswithcur-rentcross-sectionalimaging­techniques.ImagingTechniquesMDCTistheprincipalimagingtechniqueusedfortheevaluationofpatientswithlymphoma.However,evidenceindicatesthatPET/CTissuperiortoCTindetectingextranodaldiseaseintheabdomen,especiallyinthespleenandliver[1,6].TheroleofPET/CTinlow-gradelymphomasuchasMALTlymphomaiscontroversial.Fortheroutineevaluationofabdominallymphoma,nodataareavailableatpresentontheeffectivenessofMRI,andsonographyhasnorole.PatientsunsuitableforCTcanbeassessedwithMRI.SonographyandMRIcanbeusedfortargetedcharacterizationofindeterminatelesionsidentifiedatCT.Atourinstitution,routineabdominopelvicCTfortheevaluationoflymphomaisusuallyperformedafterthepatienthasdrunk900mLof2.5%dilutedsodiumamidotrizoateandmeglumineamidotrizoate(Gastrografin,BayerHealthCare)45–60minutesbeforethe198AJR:191,July2008AbdominalManifestationsofLymphomaDownloadedfrom(Ultravist370,BayerHealthCare)isadministeredIVatarateof2.5mL/s.CTisperformedaftera75-seconddelay.For16-and64-MDCTscanners,0.75-and0.6-mmdetectorsareused,respectively,with120kVpand150–180mAs.Insuspectedgastricorentericinvolve­ment,­CTisper­formedafterthepatienthasdrunk1,000–1,500mLofwateror2%sorbitol.Insuspectedcolonicinvolvement,CTisper­formedaftertheadministrationof500–1,000mLofwateror2.5%diluted­sodiumamidotrizoateandmeglumineamidotrizoate­(Gastrografin)asrectalcontrastmedium.RoutinePET/CTfortheevaluationoflymphomaisperformedafteranIVinjectionof370MBqof18F-FDGthatisadm