18F-FDG PET/CT in the clinical management of patients with lymphoma

Rev Esp Med Nucl Imagen Mol. 2017 Sep-Oct;36(5):312-321. doi: 10.1016/j.remn.2017.03.004. Epub 2017 May 5.
[Article in English, Spanish]


The aim of this work was to review the current recommendations for staging and response assessment of patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) in routine clinical practice after chemotherapy and/or stem cell transplantation. A five-point scale (5-PS) from the First International Workshop on PET in Lymphoma in Deauville, France, in 2009, was recommended as the standard tool to score imaging to assess treatment response in patients with lymphoma using 18F-Fluorodeoxyglucose (FDG) PET/CT. Following the recommendations of the 11th and 12th International Conferences on Malignant Lymphoma held in Lugano (Switzerland), in 2011 and 2013, respectively, a consensus (the so-called Lugano Classification) was reached regarding the use of PET/CT for staging and response assessment in FDG-avid lymphomas. As a result, 18F-FDG PET/CT was formally incorporated into standard staging for FDG-avid lymphomas. A bone marrow biopsy is no longer indicated for the routine staging of HL and most diffuse large B-cell lymphomas. PET/CT will be used to assess response in FDG-avid histologies using the 5-point scale. The recent introduction of biological agents with immune mechanisms requires flexibility in interpretations of the Lugano criteria due to tumour flare or a pseudo-progression effect produced by these agents. Provisional criteria have been proposed (Lymphoma Response to Immunomodulatory Therapy Criteria) with the introduction of the term 'Indeterminate Response' in order to identify this phenomenon until confirmed as flare/pseudoprogression or true progression. All these recommendations will improve evaluations of patients with lymphoma, and allow comparison of results from clinical practice and trials.

Keywords: Estadificación; Linfoma; Lymphoma; PET/CT; PET/TC; Response assessment; Staging; Transplantation; Trasplante; Tumor flare; Tumour flare; Valoración de respuesta.

Publication types

  • Review

MeSH terms

  • Fluorodeoxyglucose F18*
  • Hodgkin Disease / diagnostic imaging*
  • Hodgkin Disease / therapy
  • Humans
  • Lymphoma, Non-Hodgkin / diagnostic imaging*
  • Lymphoma, Non-Hodgkin / therapy
  • Positron Emission Tomography Computed Tomography*
  • Practice Guidelines as Topic
  • Radiopharmaceuticals*


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18