Conclusions

Imaging of the lymphoreticular system remains a real challenge in practice. Detection and assessment of pathologic involvement of lymph nodes is dependent on the presence of gross enlargement of nodes. Diffuse infiltration of spleen, liver and bone marrow are frequently undetected with all techniques. Clearly, further research and development are needed to enable detection of earlier stages of disease in lymph nodes. Imaging, despite its low accuracy when compared to histologic examination, remains, however, the best method for the staging and monitoring of known neoplasms with CT remaining the most efficacious method to date. Research in newer and more specifically targeted agents with both MRI and radionuclide methods may, in the future, enable better evaluation of this important system. In the meantime, because of the development of molecular markers which can be detected through DNA analysis after amplification with the PCR reaction, the presence of disease may reliably be assessed on small samples of tissue. It is therefore likely that more efficient image-guided needle biopsy methods that can rapidly acquire samples from multiple locations in the body will be implemented in clinical practice to supplement imaging.

Elias Zerhouni