CT template for lymphoma assessment:
CT SCAN OF NECK, CHEST ABDOMEN AND PELVIS
Post contrast CT scan of neck, chest abdomen and pelvis has been performed from skull base to ischial
tuberosity.
Indication: Staging / response assessment of lymphoma.
Comparison:
Findings:
Neck
Nodes: level/ laterality/ discrete or conglomerate / size/ morphology
Pharynx and larynx:
Oral cavity and tonsils:
Salivary glands:
Thyroid:
Vessels and carotid space:
Thorax
Lungs:
Mediastinal and hilar nodes: Absent / present/ size/ location/ extension to lungs
Trachea and bronchi:
Pleural spaces:
Heart and pericardium:
Oesophagus:
Chest wall:
Axillary nodes:
Abdomen and Pelvis
Nodes : retroperitoneal / mesenteric/ iliac / inguinal nodes - Site/ size
Liver: enlarged / normal in size.
attenuation- normal / fatty
focal lesion - present / absent
vessels- normal / periportal infiltration
Spleen: normal/ enlarged ; if enlarged size
focal lesion- present/ absent
Gall bladder:
Adrenals:
Pancreas:
Kidneys and ureters: normal / enlarged ; hydronephrosis- present/ absent
focal lesion: present / absent
perirenal space: normal / soft tissue infiltration
Stomach and bowel: unremarkable/ wall thickening / aneurysmal dilatation
Urinary bladder:
Pelvic organs:
Ascites:
Bones: normal / lytic or sclerotic lesion
Conclusion:
Staging if primary / Response assessment
Cotswolds modified Ann Arbor Staging Classification for both Hodgkin and non-Hodgkin lymphoma
CT response assessment should be based on RECIL 2017 criteria.
Cotswold’s modified Ann Arbor Staging Classification for both Hodgkin and non-Hodgkin lymphoma
stage I: one nodal group or lymphoid organ (e.g. spleen or thymus)
o stage IE: one extranodal site
stage II: two or more nodal groups, same side of the diaphragm
o stage IIE: localized extranodal site with stage II criteria, both on the same side of the diaphragm
stage III: nodal groups on both sides of the diaphragm
o stage IIIS(1): with splenic involvement
o stage IIIE(2): with localized extranodal site
o stage IIISE: both
stage IV: disseminated involvement of one or more extra lymphatic organ (e.g. lung, bone) with or without
any nodal involvement
Additional sub-staging variables:
A: asymptomatic
B: presence of B symptoms (including fever, night sweats and weight loss of over 10% of body weight over
6 months)
X: bulky nodal disease: nodal mass >1/3 of intrathoracic diameter or 10 cm in dimension
RECIL criteria for response assessment
Complete Response
Complete disappearance of all target lesions and all nodes with a long axis < 10 mm
≥ 30% decrease in sum of longest diameters of target lesions (partial response) plus
normalization of FDG-PET
Normalization of FDG-PET (Deauville score 1–3)
No bone marrow involvement
No new lesions
Reduction in the sum of diameters by ≤ 30% with normalization of FDG-PET uptake should
not be considered a complete response unless documented by negative tissue biopsy.
Partial Response
≥ 30% decrease in the sum of longest diameters of target lesions but not a complete
response
Positive FDG-PET (Deauville score 4–5)
Any bone marrow involvement
No new lesions
Minor Response
≥ 10% decrease in the sum of longest diameters of target lesions but not a partial response
Any FDG-PET findings
Any bone marrow involvement
No new lesions
Stable Disease
< 10% decrease or ≤ 20% decrease in the sum of longest diameters of target lesions
Any FDG-PET findings
Any bone marrow involvement
No new lesions
Progressive Disease
> 20% increase in the sum of longest diameter of target lesions
For small lymph nodes of < 15 mm post therapy, minimum absolute increase of 5 mm and
long diameter > 15 mm
Appearance of new lesion
Any FDG-PET finding
Any bone marrow involvement
New or no new lesions
