A patient with recently treated Hodgkin lymphoma undergoes interim FDG-PET/CT after 2 cycles of ABVD. The mediastinal mass shows a Deauville score of 5 (markedly higher FDG uptake than the liver). What does this indicate?
- A Complete metabolic response — continue current regimen
- B Progressive metabolic disease — escalation of therapy or regimen change is indicated ✓
- C Physiological post-treatment inflammation
- D Brown fat uptake — no clinical significance
Explanation
The Deauville 5-point scoring system is used for interim and end-of-treatment PET assessment in lymphoma. Deauville 5 means FDG uptake markedly higher than liver and/or new lesions, indicating progressive metabolic disease or insufficient response. In Hodgkin lymphoma, Deauville 4–5 on interim PET after 2 cycles of ABVD warrants escalation to BEACOPP or radiation therapy. Deauville 1–3 (complete or partial metabolic response) supports continuing current therapy. Post-treatment inflammation typically shows Deauville 2–3. Brown fat uptake is symmetrical, typically cervical/supraclavicular, not in a mediastinal mass.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.