Evaluation of Diffusion-Weighted MRI for Pretherapeutic Assessment and Staging of Lymphoma: Results of a Prospective Study in 140 Patients

Abstract

Purpose: To determine the value of diffusion-weighted MRI (DWI-MRI) for pretherapeutic imaging of fluorodeoxyglucose (FDG)-avid lymphoma and lymphoma with variable FDG avidity.Experimental Design: Treatment-na€ ve patients with lymphoma who were referred for whole-body staging were included in this prospective study. Group A included patients with FDG-avid lymphoma (e.g., Hodgkin, diffuse large B-cell, and follicular lymphoma), whereas Group B included patients with lymphoma of variable FDG avidity [e.g., extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT)]. All patients underwent DWI-MRI and 18F-FDG-positron emission tomography/ computed tomography (PET/CT). Region-based sensitivity and agreement with Ann Arbor staging, relative to the reference standard, were calculated for DWI-MRI, and, in Group B, also 18F-FDG-PET/CT and contrast-enhanced (CE-) CT.Results: In Group A (100 patients), DWI-MRI had a region-based sensitivity of 97%, and with regard to staging, agreed with the reference standard in 94 of 100 patients (k, 0.92). In Group B (40 patients; 38 MALT lymphomas and 2 small lymphocytic lymphomas/chronic lymphocytic leukemias), DWI-MRI, 18F-FDG-PET/CT, and CE-CT had region-based sensitivities of 94.4%, 60.9%, and 70.7%, respectively. With regard to staging in Group B, DWI-MRI, 18F-FDG-PET/CT, and CE-CT agreed with the reference standard in 37 of 40, 26 of 40, and 24 of 40 patients, with k values of 0.89, 0.52, and 0.43, respectively.Conclusions: In patients with FDG-avid lymphoma, DWI-MRI seems to be only slightly inferior to 18F-FDG-PET/CT with regard to pretherapeutic regional assessment and staging. In patients with lymphoma subtypes that show a variable FDG avidity (e.g., MALT lymphoma), DWI-MRI seems to be superior to both 18F-FDG-PET/CT and CE-CT. Clin Cancer Res; 20(11); 2984-93. Ó2014 AACR.

Evaluation of Whole Body DiffusionWeighted Imaging in the Staging and Treatment Response of Lymphoma Compared With Fluoride-Oxyglucose (FDG) PET/CT as a Reference Standard

“…Compared to PET/CT, the reported sensitivity and specificity for assessment of lymphoma with WB-DWI is 89-100% and 97-100% respectively. 20,[22][23][24] Our results for specificity of WB-DWI are comparable to that of PET/CT (93-100%) and are in line with previous observations. In contrast, our results for sensitivity were inferior to that seen in previous studies; this may be secondary to our small sample size.…”

“…Although our sample size is small, important differences have been illustrated between the imaging modalities that demonstrate the strength of PET/ CT over WB-DWI which account for superiority of PET/CT in baseline staging of lymphoma. This is supported in part by a study conducted by Mayerhoefer et al 20 that found that DWI was slightly inferior to PET/CT with regards to pre-therapeutic regional assessment and staging in patients with FDG-avid lymphoma. However, they found that this was not the case in patients with lymphoma subtypes that showed variable FDG avidity.…”

“…This is likely a combination of inherent increased sensitivity of PET imaging which is in the picomolar range 19 and relative increased susceptibility to motion artefact on MRI. 20 A further shortcoming of WB-DWI is in the assessment of bone marrow. This is particularly important during skeletal maturation.…”

Evaluation of Diffusion-Weighted Magnetic Resonance Imaging for Follow-up and Treatment Response Assessment of Lymphoma: Results of an 18F-FDG-PET/CT–Controlled Prospective Study in 64 Patients

“…Pretherapeutic staging has been previously performed and reported by our group in a larger population that also included patients eligible for the present study (34). In the present study, the performance of DWI-MRI for treatment response evaluation was determined, based on the pre-and posttherapeutic regional assessments, according to the IHP criteria of the IWG for 18F-FDG-PET/CT (30), and their application to DWI-MRI (Table 1).…”

Diagnostic Value of Diffusion-Weighted Imaging in Simultaneous 18F-FDG PET/MR Imaging for Whole-Body Staging of Women with Pelvic Malignancies

“…The use of integrated PET/CT has become well established within the last decade for whole-body staging in oncologic patients (6). Various studies investigating the diagnostic capacity of DWI or MR imaging and of PET/CT have reported comparable results for detection and characterization of tumors, including gynecologic malignancies (7)(8)(9).…”