Figure 4c. Initial staging in a 13-year-old girl with stage IV Hodgkin disease. (a, b) Fast SE STIR whole-body MR images demonstrate lymphomatous involvement as evidenced by enlarged hilar, mediastinal, and axillary lymph nodes (arrowheads in a), nodular thymus (arrowhead in b), and a hypointense focal splenic lesion (large arrow in b). Multifocal bone marrow lesions are seen in the spine, pelvis, and right femur (small arrows). (c, d) Contrast-enhanced CT images show enlarged lymph nodes, a nodular thymus, and a focal lesion in the spleen (arrow in d). (e) Anterior view from 67Ga scintigraphy helps confirm nodal involvement, seen as increased tracer uptake in left axillary and mediastinal lymph nodes (arrowheads). Skeletal involvement is visible only in the sacrum (arrows); the other bone marrow lesions seen on MR images are not evident. Results from a previous blind bone marrow biopsy had been negative.