The role of computed tomography in the initial staging and subsequent management of the lymphomas

To assess the full potential of computed tomography (CT) in the investigation and management of malignant lymphomas, a series of 160 patients with both Hodgkin's and non-Hodgkin's lymphomas was reviewed. Eighty-eight patients were newly diagnosed and previously untreated, while the remaining 72 who had already received treatment presented either as problems of management or with suspected recurrence of the disease. Computed tomography compared favorably with lymphography as a valuable investigation in the assessment of abdominal and pelvic lymph node involvement. Furthermore, CT added extra information on the full extent of the disease, particularly in those areas not detectable by conventional studies (high paraaortic, retrocrural, mesenteric, splenic, and hepatic hilar nodes). The overall distribution of lymph node involvement both above and below the diaphragm in the two groups of lymphomas was assessed prior to treatment and any obvious differences noted. At the same time, extranodal involvement was analyzed and found to be more difficult to interpret. The value of CT in changing the staging across the diaphragm was recognized. Clinical, CT, and laparotomy findings were correlated in 22 untreated patients with Hodgkin's lymphoma. In conclusion, the role of CT in the initial treatment planning, in the subsequent monitoring of treatment response, and in the assessment of disease recurrence was evaluated.