Imaging Studies

Imaging studies—such as PET/CT and CT scans—have become the standards that provide a baseline against which treatment response can be more accurately assessed.1

PET-CT scan

Chest/abdominal/pelvic (C/A/P) CT scan with contrast of diagnostic quality and/or whole-body PET/CT scan are required for diagnosis of MZL.2

Additional imaging studies may be useful in the diagnosis of MZL in select cases2:

  • Echocardiogram or MUGA scan if cardiotoxic chemotherapies are indicated (gastric MALT, nodal MZL)
  • MRI with contrast for neurologic evaluation or for patients for whom CT with contrast is contraindicated (nongastric MALT)
  • Endoscopy with ultrasound (if available) with multiple biopsies of anatomical sites (gastric and nongastric MALT)
  • Additional imaging as appropriate

Imaging studies may be ordered at initial diagnosis, staging, and when evaluating treatment response.1

  • Contrast-enhanced CT is preferred for radiation treatment planning and for distinguishing bowel from lymphadenopathy1
  • PET/CT is the standard for routine staging of FDG*-avid, nodal lymphomas (lymphomas whose ‘hot’ nodes or tumors take up the FGD), whereas CT is indicated for nonavid histologies1
    • While a majority of nodal lymphoma histologies are considered FDG-avid, MZL is nonavid 1
    • Although PET/CT is generally not useful for staging these more indolent histologies, it may be helpful in some circumstances (eg, to identify a preferred biopsy site if aggressive transformation is suspected)1

*FDG (fluorodeoxyglucose) is a dye that is picked up by the PET scan.

CT, computerized tomography; FDG-PET, fluorodeoxyglucose (FDG)-positron emission tomography (PET); PET/CT, positron emission tomography-computed tomography.

References: 1. Cheson BD et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014;32(27):3059-3067. 2. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for B-Cell Lymphomas V.4.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed July 10, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.