Purpose18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is the reference standard in staging of 18F-FDG-avid lymphomas; however, there is no recommended functional imaging modality for indolent lymphomas. Therefore, we aimed to compare the performance of whole-body magnetic resonance imaging (WB-MRI) with that of 18F-FDG PET/CT for lesion detection and initial staging in patients with aggressive or indolent lymphoma.Materials and methodsWe searched the MEDLINE, EMBASE, and CENTRAL databases for studies that compared WB-MRI with 18F-FDG PET/CT for lymphoma staging or lesion detection. The methodological quality of the studies was assessed using version 2 of the “Quality Assessment of Diagnostic Accuracy Studies” tool. The pooled staging accuracy (μ) of WB-MRI and 18F-FDG PET/CT for initial staging and for assessing possible heterogeneity (χ2) across studies were calculated using commercially available software.ResultsEight studies comprising 338 patients were included. In terms of staging, the meta-analytic staging accuracies of WB-MRI and 18F-FDG PET/CT for Hodgkin lymphoma and aggressive non-Hodgkin lymphoma (NHL) were 98% (95% CI, 94%–100%) and 98% (95% CI, 94%–100%), respectively. The pooled staging accuracy of 18F-FDG PET/CT dropped to 87% (95% CI, 72%–97%) for staging in patients with indolent lymphoma, whereas that of WB-MRI remained 96% (95% CI, 91%–100%). Subgroup analysis indicated an even lower staging accuracy of 18F-FDG PET/CT for staging of less FDG-avid indolent NHLs (60%; 95% CI, 23%–92%), in contrast to the superior performance of WB-MRI (98%; 95% CI, 88%–100%).ConclusionWB-MRI is a promising radiation-free imaging technique that may serve as a viable alternative to 18F-FDG PET/CT for staging of 18FDG-avid lymphomas, where 18F-FDG PET/CT remains the standard of care. Additionally, WB-MRI seems a less histology-dependent functional imaging test than 18F-FDG PET/CT and may be the imaging test of choice for staging of indolent NHLs with low 18F-FDG avidity.
Background 18 F-FDG PET and 131 I scans are important in the detection of metastases from differentiated thyroid carcinoma (DTC). The relationship of FDG and radioiodine (RAI) metabolism in bone metastases (BMs) from DTC and its prognostic value on RAI treatment is not clear. Methods The retrospective study included DTC patients with BMs from two medical centers, who underwent 18 F-FDG PET/CT scans and RAI therapy. Therapeutic response was evaluated by serum thyroglobulin (Tg) levels and anatomical imaging changes. Results The analyses were performed on 30 patients with 72 BMs. Forty-two (42/72, 58%) lesions displayed simultaneous 131 I and 18 F-FDG uptake. BMs with positive 18 F-FDG uptake had a less favorable response to RAI therapy in comparison to those with negative 18 F-FDG uptake ( p = 0.018), even in 131 I-avid lesions ( p = 0.033). Sixteen (53%) patients had disease progression with a median PFI of 26 months (range: 3 to 89 months). Compared to those with 131 I-avid but non-FDG-avid BMs, patients presenting with 18 F-FDG-avid BMs had shorter PFI, whether with 131 I uptake (p = 0.002) or without (p = 0.002). Conclusion More than half of BMs (58%) from DTC show simultaneous 18 F-FDG and 131 I uptakes which are contrary to the flip-flop phenomenon ( 131 I negative and 18 F-FDG positive). Regardless of 131 I uptake, 18 F-FDG uptake of BMs portends a less favorable therapeutic response and poorer prognosis for patients with DTC.
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