Imaging in follicular NHL

Imaging contributes to management of follicular lymphoma (FL) through guiding biopsy, determining disease stage and assessing therapeutic response. Molecular imaging with positron emission tomography (PET), especially when combined with computer tomography (PET/CT), is more accurate than conventional imaging and extends the role of imaging to lesion characterisation, including non-invasive assessment of high-grade transformation. There is strong data to support the use of FDG PET/CT for primary staging, resulting in significant management change. In patients with early stage follicular lymphoma (stage I or II), there is a clear role for PET/CT to avoid futile involved-field radiotherapy in patients with widespread disease and to optimise the treatment field in patients with confirmed localised disease. For restaging, use of PET/CT allows discrimination between scar tissue and viable tumour in residual masses. Molecular imaging is likely to play an increasing role in selection of patients for specific treatments and in prognostic stratification.