Hypodense volumes (HDV) in mediastinal masses can be visualized in a computed tomography scan in Hodgkin lymphoma. We analyzed staging CT scans of 1178 patients with mediastinal involvement from the EuroNet-PHL-C1 trial and explored correlations of HDV with patient characteristics, mediastinal tumor volume and progression-free survival. HDV occurred in 350 of 1178 patients (29.7%), typically in larger mediastinal volumes. There were different patterns in appearance with single lesions found in 243 patients (69.4%), multiple lesions in 107 patients (30.6%). Well delineated lesions were found in 248 cases (70.1%), diffuse lesions were seen in 102 cases (29.1%). Clinically, B symptoms occurred more often in patients with HDV (47.7% compared to 35.0% without HDV (p = 0.039)) and patients with HDV tended to be in higher risk groups. Inadequate overall early-18F-FDG-PET-response was strongly correlated with the occurrence of hypodense lesions (p < 0.001). Patients with total HDV > 40 ml (n = 80) had a 5 year PFS of 79.6% compared to 89.7% (p = 0.01) in patients with HDV < 40 ml or no HDV. This difference in PFS is not caused by treatment group alone. HDV is a common phenomenon in HL with mediastinal involvement.

Department of Medical Oncology and Radiotherapy Oslo University Hospital Oslo Norway

Department of Nuclear Medicine University of Leipzig Leipzig Germany

Department of Oncology St Jude Children's Research Hospital Memphis TN USA

Department of Paediatric Oncology Royal Hospital for Sick Children University of Edinburgh Edinburgh UK

Department of Pediatric Hematology and Oncology Justus Liebig University Gießen Germany

Department of Pediatric Hematology and Oncology Our Lady's Children's Hospital Dublin Ireland

Department of Pediatric Hematology and Oncology St Anna Children's Hospital Medical University of Vienna Vienna Austria

Department of Pediatric Hematology and Oncology University Children's Hospital Bratislava Slovakia

Department of Pediatric Hematology and Oncology University College London Hospitals London UK

Department of Pediatric Hematology and Oncology University Hospital Motol and 2nd Medical Faculty of Charles University Prague Czech Republic

Department of Pediatric Hematology and Oncology University Hospitals Leuven Leuven Belgium

Department of Radiation Oncology Medical Faculty of the Martin Luther University Halle Germany

Department of Radiation Oncology University Hospital Vienna Vienna Austria

Department of Radiology University Hospital Halle Saale Ernst Grube Strasse 40 06120 Halle Saale Germany

Division of Pediatrics Department of Woman Mother Child Pediatric Hematology Oncology Unit University Hospital of Lausanne Lausanne Switzerland

Erasmus MC Sophia Children's Hospital Rotterdam The Netherlands

Hôpital Armand Trousseau Sorbonne Universitè Paris France

Institute of Medical Informatics Statistics and Epidemiology University of Leipzig Leipzig Germany

Institute of Pediatrics Jagiellonian University Medical College Krakow Poland

Karolinska University Hospital Astrid Lindgrens Childrens Hospital Stockholm Sweden

Pediatric Hematology Oncology and Stem Cell Transplantation Dr Von Hauner University Children's Hospital Ludwig Maximilians University Munich Germany

Pediatric Onco Hematology Unit Hospital Universitario Virgen Macarena Sevilla Spain

Pediatric Oncology and Hematology Department of Pediatrics and Adolescent Medicine University Hospital Erlangen Germany

Princess Màxima Center for Pediatric Oncology Utrecht The Netherlands

Service d'Hématologie Pédiatrique Hôpital Robert Debré Paris France

St Anna Children's Cancer Research Institute Vienna Austria

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