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Background
Follicular lymphoma is the most common type of indolent B-cell non-Hodgkin lymphoma, routinely encountered in the radiology department for both initial staging exams and when assessing response to therapy. Follicular lymphoma has a wide range of imaging presentations with both nodal and extra-nodal disease manifesting in multiple organ systems. The purpose of this educational exhibit is to provide a pictorial, case-based review of the various imaging manifestations and post-therapy assessment of follicular lymphoma by 18F-FDG PET/CT.

Educational Goals / Teaching Points
Recognize the various manifestations of follicular lymphoma by 18F-FDG PET/CT through case examples. Accurately utilize the Deauville five-point scale for assessment of treatment response. Review imaging findings and relevant clinical data points in cases of histologic transformation to aggressive lymphomas. Understand the role of 18F-FDG PET/CT in guiding percutaneous biopsies and the importance of SUV max in lesion selection. Target audience of this exhibit includes radiology residents, fellows and general radiologists practicing nuclear medicine.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Anatomic and physiologic manifestations of follicular lymphoma by 18F-FDG PET/CT including nodal and extra-nodal disease. Deauville five-point scale for the assessment of treatment response. 18F-FDG PET/CT findings concerning for histologic transformation to aggressive lymphoma (SUV greater than or equal to 13). 18F-FDG PET/CT as a guide to CT and ultrasound-guided percutaneous biopsy.

Conclusion
Follicular lymphoma is a common, low-grade lymphoma that nuclear medicine physicians routinely are required to stage and assess response to treatment. Knowledge of the various disease manifestations throughout multiple organ systems, and the ability to stage and assess treatment response by 18F-FDG PET/CT is essential to clinical practice.