Hodgkin disease: clinical utility of CT in initial staging and treatment

One hundred seven consecutive new cases of Hodgkin disease were evaluated with chest radiography and computed tomography (CT) for initial staging. The data were evaluated with regard to five popular treatment protocols for Hodgkin disease. Thoracic CT scans were normal in 30 of 31 patients who had normal radiographs. In the remaining 76 patients, CT demonstrated 194 new sites of disease and disproved 25 suspected sites of disease. The use of CT scans changed the staging of disease in 20 patients, 16 of whom had extranodal extension. The effect of using CT findings on treatment depended on whether radiation therapy was used, and, if so, which treatment protocol was followed. The use of CT findings would have changed the treatment in 6.5%-62.7% of new cases of Hodgkin disease. The authors recommend that CT scans be obtained in all patients with Hodgkin disease, especially those with abnormal chest radiographs.