Clinical impact of contrast-enhanced computed tomography combined with low-dose ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography on routine lymphoma patient management

Abstract

This study evaluated the clinical impact of contrast-enhanced computed tomography (CECT) on routine management of patients with lymphoma. Over a 1-year period, 237 CECT scans were performed prospectively in 163 patients after low-dose ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT). Scans were performed at staging (n = 41), interim (n = 73), post-therapy (n = 115) and follow-up (n = 8). Clinical impact was determined from the multidisciplinary committee reports. CECT had no clinical impact in 219 cases (92%). A clear impact was noted in only 3%, i.e. up-staging of lymphoma (n = 2) and diagnosis of deep vein thrombosis (n = 5). A debatable impact was noted in the remaining 11 cases, consisting of additional investigations, either without therapeutic impact (n = 8), or resulting in delay of therapy onset (n = 2) or ablative surgery (n = 1). CECT delivered an average 33.5 ± 3.8 mSv vs. 17.7 ± 2.8 mSv for PET/CT. In conclusion, the clinical impact of CECT seems limited, although scarce, life-threatening conditions were diagnosed. Imaging of lymphoma needs optimization to reduce radiation exposure.

Keywords::

• Contrast-enhanced CT
• low-dose PET/CT
• lymphoma
• patient management
• radiation exposure

Acknowledgements

This study was supported by the Management School of the Assistance Publique-Hopitaux de Paris and the École Nationale Supérieure des Mines de Paris (EMAMH).

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