The radiologist plays a key role in the management of patients with lymphoma at several stages, from initial diagnosis through to the evaluation of response to treatment. The possible diagnosis of lymphoma is often raised first by the imaging department. The alert radiologist who identifies an abnormal mediastinum on a chest radiograph may consider lymphoma in their diagnosis, and this may prompt further investigations. With the increasing advent of computed tomography (CT) for all thoracic and abdominal problems, the imaging findings may again point to a very strong likelihood of lymphoma being the responsible cause. A referral from a general practitioner about a patient with a neck lump may lead to an ultrasound examination. Frequently, tissue for histopathological examination is obtained by the radiologist using image-guided techniques, either at ultrasound (US) or CT. It is important when performing these procedures that the radiologist endeavors to obtain good core biopsies with sufficient tissue for full histopathological evaluation. Fine needle aspiration is often inadequate for accurate diagnosis and should be avoided.
Accurate delineation of the extent of disease is essential both at initial presentation and follow-up as this is used to guide management decisions. As lymphoma may involve almost any tissue in the body, a variety of imaging techniques may be required to demonstrate it, both anatomically and functionally, depending upon the tumor biology and location. Moreover, as treatment regimens develop, it is important that the radiologist is able to recognize complications of therapy.