DOI: 10.1148/rg.275065157
Multimodality Imaging of Hodgkin Disease and Non-Hodgkin Lymphomas in Children1
Paolo Toma, MD,
Claudio Granata, MD,
Andrea Rossi, MD, and
Alberto Garaventa, MD
1 From the Departments of Radiology (P.T., C.G.), Neuroradiology (A.R.), and Oncology (A.G.), Giannina Gaslini Children’s Hospital, Largo Gaslini 5, 16147 Genoa, Italy. Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received August 24, 2006; revision requested November 14 and received February 28, 2007; accepted March 26. All authors have no financial relationships to disclose.
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Figure 1. NHL of the neck in a 4-year-old boy. Coronal contrast-enhanced T1-weighted MR image shows a large laterocervical mass (M) involving the parapharyngeal space. Infiltration of the left cavernous sinus (arrow) and dural involvement with intracranial extension are evident. (Reprinted, with permission, from (23).
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Figure 2a. HD in a 6-year-old girl. (a) Coronal T2-weighted MR image shows a left-sided paraspinal mass (arrowhead). The second, third, and fourth lumbar vertebrae and first sacral vertebra show infiltration (*). (b) Axial contrast-enhanced T1-weighted MR image shows extension into the spinal canal (arrows) and compression of the dural sac (arrowhead).
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Figure 2b. HD in a 6-year-old girl. (a) Coronal T2-weighted MR image shows a left-sided paraspinal mass (arrowhead). The second, third, and fourth lumbar vertebrae and first sacral vertebra show infiltration (*). (b) Axial contrast-enhanced T1-weighted MR image shows extension into the spinal canal (arrows) and compression of the dural sac (arrowhead).
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Figure 3. Burkitt lymphoma of the palatine tonsils in
a 3-year-old boy. Sagittal contrast-enhanced T1-weighted MR image shows a
huge, well-defined mass (M) of the soft tissues of the
rhinopharynx that penetrates into the nasal choanae. (Reprinted, with
permission, from (23).
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Figure 4a. HD of the cervical lymph nodes in a 12-year-old girl. (a) US scan shows lymphomatous infiltration of a cervical lymph node, which appears enlarged, nonhomogeneous, and partially hyperechoic. (b) Three-dimensional power Doppler US scan of the same lymph node shows distorted vascular branching and vessel amputation.
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Figure 4b. HD of the cervical lymph nodes in a 12-year-old girl. (a) US scan shows lymphomatous infiltration of a cervical lymph node, which appears enlarged, nonhomogeneous, and partially hyperechoic. (b) Three-dimensional power Doppler US scan of the same lymph node shows distorted vascular branching and vessel amputation.
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Figure 5. HD of the cervical lymph nodes in a 10-year-old girl with a right lateral cervical mass. US scan shows multiple roundish, hypoechoic lymph nodes with a tendency to aggregate. The nodal hila are not visualized or appear eccentric (arrowheads).
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Figure 6a. NHL in a 10-year-old girl. (a) US scan of the right parotid gland shows infiltration, which appears as an ill-defined, nonhomogeneous hypoechoic area (arrowheads). (b) Coronal T1-weighted MR image shows that the infiltrated gland (M) is isointense relative to the neck muscles.
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Figure 6b. NHL in a 10-year-old girl. (a) US scan of the right parotid gland shows infiltration, which appears as an ill-defined, nonhomogeneous hypoechoic area (arrowheads). (b) Coronal T1-weighted MR image shows that the infiltrated gland (M) is isointense relative to the neck muscles.
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Figure 7. HD in a 17-year-old boy. Contrast-enhanced CT scan obtained at diagnosis shows a large mediastinal mass (M) that extends to the right pulmonary apex and the right side. The trachea (T) is compressed, and the great vessels (arrowheads) are displaced.
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Figure 8. NHL in a 14-year-old boy. Contrast-enhanced CT scan obtained at diagnosis shows a large anterior mediastinal mass (M) that originates from the thymus. A few cysts with central low attenuation and a peripheral enhancing ring are present (arrowheads).
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Figure 9. NHL in a 13-year-old boy. Contrast-enhanced CT scan obtained at diagnosis shows a large anterior mediastinal mass (M) that originates from the thymus. A cluster of calcifications is present (arrowheads).
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Figure 10. HD in a 10-year-old boy. CT scan obtained below the carina shows multiple nodular lesions and interstitial thickening in both lungs. Enlarged hilar lymph nodes (LN) are present.
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Figure 11. HD in a 12-year-old boy. CT scan obtained through the bases of the lungs shows a large infiltrate (solid arrow) with a cavitary lesion (open arrow) in the right lower lobe. Small nodules (arrowheads) are present in the left lower lobe.
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Figure 12. HD in a 10-year-old boy. CT scan obtained at diagnosis shows consolidation (arrow) of the anterior basal segment of the right lower lobe and the lateral segment of the right middle lobe, a finding that mimics pneumonia.
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Figure 14. NHL in a 12-year-old boy. Radiograph from a barium meal study shows narrowing and distortion of the first portion of the duodenum (arrow) as a result of lymphomatous infiltration.
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Figure 15a. NHL in a 14-year-old boy. (a) US scan of an infiltrated small bowel loop shows severe thickening, loss of stratification, hyperemia, and aneurysmal dilatation. (b) Contrast-enhanced CT scan shows conglomeration of the bowel, mesentery, and mesenteric vessels into a huge lymphomatous mass. Aneurysmal dilatation of a bowel loop (arrowhead) is also seen.
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Figure 15b. NHL in a 14-year-old boy. (a) US scan of an infiltrated small bowel loop shows severe thickening, loss of stratification, hyperemia, and aneurysmal dilatation. (b) Contrast-enhanced CT scan shows conglomeration of the bowel, mesentery, and mesenteric vessels into a huge lymphomatous mass. Aneurysmal dilatation of a bowel loop (arrowhead) is also seen.
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Figure 16a. NHL in an 11-year-old boy. (a) US scan shows encasement of the mesenteric vessels by a lymphomatous mass that originates from multiple enlarged and confluent lymph nodes (the sandwich sign) (arrowheads). The splenic vein (arrow) is in close contact with the mass. (b) Contrast-enhanced CT scan shows the large lymphomatous mass (M) encasing the mesenteric vessels (arrow).
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Figure 16b. NHL in an 11-year-old boy. (a) US scan shows encasement of the mesenteric vessels by a lymphomatous mass that originates from multiple enlarged and confluent lymph nodes (the sandwich sign) (arrowheads). The splenic vein (arrow) is in close contact with the mass. (b) Contrast-enhanced CT scan shows the large lymphomatous mass (M) encasing the mesenteric vessels (arrow).
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Figure 18a. HD in a 12-year-old girl. (a) US scan shows splenic infiltration, which has a diffusely nonhomogeneous appearance with small hypoechoic nodules. (b) Contrast-enhanced CT scan shows an enlarged spleen with a diffusely nonhomogeneous appearance.
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Figure 18b. HD in a 12-year-old girl. (a) US scan shows splenic infiltration, which has a diffusely nonhomogeneous appearance with small hypoechoic nodules. (b) Contrast-enhanced CT scan shows an enlarged spleen with a diffusely nonhomogeneous appearance.
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Figure 19a. NHL in a 16-year-old girl. (a) US scan shows a large hypoechoic nodule (M) in the right hepatic lobe. K = kidney, L = liver. (b) Contrast-enhanced CT scan shows low-attenuation nodular lesions (arrowheads). A few discrete lesions are evident in both hepatic lobes, with small nodules in the spleen and right kidney.
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Figure 19b. NHL in a 16-year-old girl. (a) US scan shows a large hypoechoic nodule (M) in the right hepatic lobe. K = kidney, L = liver. (b) Contrast-enhanced CT scan shows low-attenuation nodular lesions (arrowheads). A few discrete lesions are evident in both hepatic lobes, with small nodules in the spleen and right kidney.
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Figure 20. NHL in a 16-year-old boy with disseminated preterminal disease. On a US scan, parts of the pancreatic body and tail are enlarged and hypoechoic (arrowheads) owing to lymphomatous infiltration.
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Figure 25a. NHL in a 14-year-old boy. (a) US scan shows an enlarged testis with diffuse and nonhomogeneous lymphomatous infiltration. The mediastinum testis is not visualized. (b) Color Doppler US scan shows intense hyperemia of the testis.
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Figure 25b. NHL in a 14-year-old boy. (a) US scan shows an enlarged testis with diffuse and nonhomogeneous lymphomatous infiltration. The mediastinum testis is not visualized. (b) Color Doppler US scan shows intense hyperemia of the testis.
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Figure 26a. NHL at onset in an 11-year-old boy. (a) CT scan shows thickening of cortical bone in the right ilium with irregular periosteal and endosteal reaction (arrowheads). (b) Axial contrast-enhanced T1-weighted MR image shows nonhomogeneity of the right iliac bone (*) with enhancement of the adjacent soft tissues (arrowheads).
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Figure 26b. NHL at onset in an 11-year-old boy. (a) CT scan shows thickening of cortical bone in the right ilium with irregular periosteal and endosteal reaction (arrowheads). (b) Axial contrast-enhanced T1-weighted MR image shows nonhomogeneity of the right iliac bone (*) with enhancement of the adjacent soft tissues (arrowheads).
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Figure 27a. NHL in an 8-year-old boy. MR images of the right humerus show diffuse involvement of the bone, a finding suggestive of malignant growth. (a) T1-weighted image shows abnormally hypointense tissue in the shaft and both metaphyses, findings suggestive of infiltration. (b, c) On T2-weighted (b) and contrast-enhanced T1-weighted (c) images, the abnormal tissue is nonhomogeneously hyperintense (* in c). There is an associated soft-tissue mass (arrowheads) growing through the periosteum.
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Figure 27b. NHL in an 8-year-old boy. MR images of the right humerus show diffuse involvement of the bone, a finding suggestive of malignant growth. (a) T1-weighted image shows abnormally hypointense tissue in the shaft and both metaphyses, findings suggestive of infiltration. (b, c) On T2-weighted (b) and contrast-enhanced T1-weighted (c) images, the abnormal tissue is nonhomogeneously hyperintense (* in c). There is an associated soft-tissue mass (arrowheads) growing through the periosteum.
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Figure 27c. NHL in an 8-year-old boy. MR images of the right humerus show diffuse involvement of the bone, a finding suggestive of malignant growth. (a) T1-weighted image shows abnormally hypointense tissue in the shaft and both metaphyses, findings suggestive of infiltration. (b, c) On T2-weighted (b) and contrast-enhanced T1-weighted (c) images, the abnormal tissue is nonhomogeneously hyperintense (* in c). There is an associated soft-tissue mass (arrowheads) growing through the periosteum.
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Copyright © 2007 by the Radiological Society of North America.
