What is the role of nuclear imaging in the workup of thoracic non-Hodgkin lymphoma (NHL)?

Updated: Mar 05, 2019
  • Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR; Chief Editor: Eugene C Lin, MD  more...
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Technetium-99m (99mTc) pertechnetate, as well as iodine-131 (131I) or iodine-123 (123I), is used to identify aberrant thyroid tissue in the anterior mediastinum, as well as goiters and thyroid neoplasms in the mediastinal thyroid gland (see the images below). Radioiodine scans are particularly useful in identifying anterior mediastinal masses at the level of the thoracic inlet, such as the substernal extension of cervical thyroid goiter. Because lymphomas and thyroid abnormalities may appear as anterior mediastinal masses, these radionuclides may help confirm or eliminate thyroid tissue as the cause of an anterior mediastinal mass. [9, 10, 11, 12, 13, 14, 15, 19]

Posterior bone scan shows no abnormally increased Posterior bone scan shows no abnormally increased uptake in the thoracic vertebrae. Image shows an unusual pattern of non-Hodgkin lymphoma (NHL) of the upper thoracic vertebra.
This 28-year-old man was being evaluated for fever This 28-year-old man was being evaluated for fever of unknown origin. Gallium-67 study shows extensive uptake in the mediastinal lymph nodes due to non-Hodgkin lymphoma (NHL).
Gallium-67 (67Ga) scan shows the intrathoracic lym Gallium-67 (67Ga) scan shows the intrathoracic lymphoma to be 67Ga avid.
Positron emission tomography (PET) CT in an 80-yea Positron emission tomography (PET) CT in an 80-year-old woman with diffuse, large B-cell NHL of the skin and subcutaneous tissues that recently transformed from prior low-grade non-Hodgkin lymphoma (NHL). CT scan of the lower neck shows several subcutaneous nodules of varying size with variable uptake on PET (arrows).
Positron emission tomography (PET) CT in an 80-yea Positron emission tomography (PET) CT in an 80-year-old woman with diffuse, large B-cell NHL of the skin and subcutaneous tissues that recently transformed from previous low-grade non-Hodgkin lymphoma (NHL) in the same patient as in the previous image. PET shows high level of uptake in the anterior subcutaneous nodule in the chest (white arrows). CT scan of similar nodules (arrowheads) on the anterior left chest does not show PET uptake; these may represent regions of lower-grade NHL. PET image of posterior lesions shows only mild uptake (gray arrow).

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