Clinical utility of thoracic CT in the initial staging of Hodgkin disease

Seventy-four patients with newly diagnosed Hodgkin disease, including 22 with normal chest radiographs, underwent thoracic CT. CT detected 126 additional sites of disease, which led to reassignment of clinical stage in 15 patients. In those patients primarily treated with chemotherapy, findings on thoracic CT led to no change in treatment. In those patients primarily treated with radiation, the treatment changes consequent on thoracic CT findings depended on the radiation therapy philosophy employed. If a full unblocked mantle dose had been given for disease detected on just the chest radiography, the thoracic CT findings caused no further treatment changes. If, however, a subcarinal/heart block had been used or if whole lung radiation had been given for hilar adenopathy, the additional findings on thoracic CT would have caused radiation therapy changes in 15 patients