• Hanneke P van Hamersvelt, Thomas C Kwee, Rob Fijnheer, Frederik J A Beek, John M H de Klerk, and Rutger A J Nievelstein.
• From the *Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; †Department of Hematology, and ‡Department of Nuclear Medicine, Meander Medical Center Amersfoort, Amersfoort, The Netherlands.
• J Comput Assist Tomogr. 2014 Jul 1; 38 (4): 620-5.

ObjectiveTo determine whether full-dose contrast-enhanced computed tomography (CT) (CECT) can be omitted from an F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) (FDG-PET)/CT staging examination in newly diagnosed FDG-avid lymphoma.MethodsTwenty-nine patients with newly diagnosed FDG-avid lymphoma prospectively underwent unenhanced low-dose FDG-PET/CT and CECT. Different observers evaluated unenhanced low-dose FDG-PET/CT and CECT in a blinded manner. Ann Arbor stages according to unenhanced low-dose FDG-PET/CT and CECT were compared, and discrepancies between the 2 imaging modalities were resolved using bone marrow biopsy and posttreatment FDG-PET/CT as reference standard. Finally, it was assessed as to how many cases therapy would have been changed based on additional CECT findings.ResultsIn 27 of 29 patients (93%; 95% confidence interval, 78%-98%), CECT either did not change or did not correctly change the Ann Arbor stage that was assigned according to unenhanced low-dose FDG-PET findings. In 2 of 29 patients (7%; 95% confidence interval, 2%-22%), CECT correctly provided another Ann Arbor stage than unenhanced low-dose FDG-PET/CT. In the latter 2 cases, therapy would not have been changed based on additional CECT findings.ConclusionsUnenhanced low-dose FDG-PET/CT alone is suggested as the primary imaging modality of choice for staging patients with newly diagnosed FDG-avid lymphoma. This diagnostic approach is particularly indicated in younger patients in whom diagnostic radiation exposure should be minimized and in patients who are at increased risk of CT contrast-induced allergic reactions or nephropathy.

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