title: Imaging of primary pediatric lymphoma of bone.
abstract: BACKGROUND
  Primary pediatric bone lymphoma is a rare form of non-Hodgkin lymphoma. Unlike nodal forms of lymphoma, imaging abnormalities in lymphoma of bone do not resolve rapidly in conjunction with treatment and radiologic findings can remain abnormal for years, making it difficult to evaluate treatment response.
  
  
  OBJECTIVE
  To evaluate the utility of imaging in assessment of patients with primary pediatric bone lymphoma.
  
  
  METHODS
  At our institution between 2004 and 2013, six cases of pathology-proven primary pediatric bone lymphoma were diagnosed. Retrospective chart review was performed to assess imaging utilization. Our data were qualitatively compared with existing literature to construct an algorithm for imaging patients with primary lymphoma of bone.
  
  
  RESULTS
  Imaging evaluation of patients with primary pediatric bone lymphoma was highly variable at our institution. Conventional imaging was routinely used to evaluate response to treatment, despite lack of appreciable osseous change. Imaging in the absence of symptoms did not alter clinical management. Only positron emission tomography CT (PET/CT) proved capable of demonstrating imaging changes from the pretreatment to the post-treatment scans that were consistent with the clinical response to treatment.
  
  
  CONCLUSIONS
  Surveillance imaging is likely unnecessary in patients with a known diagnosis of pediatric lymphoma of bone. Pretreatment and post-treatment PET/CT is likely sufficient to assess response. There is little data to support the use of interim and surveillance PET/CT.
authors.affiliation: Department of Pediatric Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA. ks.mueller@gmail.com.
authors.forename: Kathryn S
authors.initials: KS
authors.lastname: Milks
authors.affiliation: Department of Pediatric Hematology Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: McLean
authors.affiliation: Department of Radiology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
authors.forename: Evelyn Y
authors.initials: EY
authors.lastname: Anthony
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000000981:diagnostic imaging*; D001842:Bone and Bones / Q000000981:diagnostic imaging; D002648:Child; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000000981:diagnostic imaging*; D008297:Male; D012189:Retrospective Studies
keywords: Bone; Children; Lymphoma; Non-Hodgkin lymphoma; Positron emission tomography/computed tomography