Whole-body diffusion-weighted magnetic resonance imaging versus FDG-PET/CT for initial lymphoma staging: systematic review on diagnostic test accuracy studies

Abstract

CONTEXT AND OBJECTIVE: Positron emission tomography with [18]F-fluoro-2-deoxyglucose (FDG-PET/CT) has been advocated as the method of choice for lymphoma staging, since it enables whole-body analysis with high sensitivity for detection of affected areas and because it combines capacities for anatomical and functional assessment. With technological advances, magnetic resonance imaging (MRI) has emerged as an alternative to FDG-PET/CT. This systematic review with meta-analysis aimed to compare whole-body diffusion-weighted MRI (WB-MRI) with FDG-PET/CT for lymphoma staging. DESIGN AND SETTING: Systematic review on diagnostic test accuracy studies conducted at a public university. METHODS: The Medline, Scopus, Embase and Lilacs databases were searched for studies published up to September 2013 that compared WB-MRI and FDG-PET/CT for lymphoma staging. The reference lists of included studies were checked for any relevant additional citations. RESULTS: Six studies that evaluated the initial lymphoma staging in 116 patients were included. WB-MRI and FDG-PET/CT agreed in 90.5% of the cases (κ = 0.871; P < 0.0001). In most of the studies, when there was disagreement between the methods, WB-MRI overstaged in relation to FDG-PET/CT. The sensitivity of WB-MRI and FDG-PET/CT, in comparison with the clinical-radiological standard, ranged from 59 to 100% and from 63 to 100% respectively. CONCLUSION: WB-MRI is a highly sensitive method for initial lymphoma staging. It has excellent agreement with FDG-PET/CT and is a great alternative for managing lymphoma patients, without using ionizing radiation or an intravenous contrast agent.

Whole-Body MR Imaging: Musculoskeletal Applications

“…The advent of DWI and new contrast materials strengthens the value of whole-body MR imaging in the management of lymphoma, beside PET, for the detection of bone, lymph node, and visceral lesions and evaluation of their response to treatment (11,75,86,87). A meta-analysis grouping 116 patients points to good to excellent agreement between whole-body MR imaging/DWI and PET/CT findings for lymphoma staging and their similar sensitivity compared with clinical-radiologic standards for the staging of lymphoma (88).…”

Malignant Lymphoma in the Psoas Major Muscle

“…Notably, the lymphoma lesion in the present case showed markedly high intensity on diffusion-weighted imaging, reflecting the high cellularity and high nucleus-to-cytoplasm ratio of lymphomas and leading to restricted diffusion [9]. Recent studies have indicated the importance of diffusion-weighted imaging for lymphoma staging as well as functional and quantitative evaluation of lymphoma lesions after treatment [9, 10]. Giraudo et al [11] reported that the combined use of F-FDG-PET and MRI, including diffusion-weighted imaging, showed higher diagnostic sensitivity than did the combined use of F-FDG-PET and CT in patients with lymphoma.…”

Diagnostic accuracy of diffusion‐weighted imaging‐ magnetic resonance imaging compared to positron emission tomography/computed tomography in evaluating and assessing pathological response to treatment in adult patients with lymphoma: A systematic review

“…Of note, Herrmann et al 17 used quantitative ADC in their assessment of treatment response compared to PET/CT and PET/MRI. Quantitative ADC analysis has been shown to reduce false positives in previous studies 13 especially where there is T2 'shine-through' due to prolonged T2 relaxation times. 26 The Herrmann study was unique in this series, as it used a defined quantitative threshold (1.2 9 10 À3 mm/s 2 ) to define lesion positivity.…”

“…Patients with poorly controlled diabetes may not be suitable for PET/CT, as this may reduce the sensitivity of PET/CT in the assessment of malignancies. 12 The recent investigation of whole body diffusionweighted magnetic resonance imaging (WB-DWI-MRI) as a possible modality to stage patients 13 has raised the possibility of its use in assessing treatment response during chemotherapy, especially for diabetic patients or those with a specific allergy to intravenous contrast agents.…”