Whole Body 3.0 T Magnetic Resonance Imaging in Lymphomas: Comparison of Different Sequence Combinations for Staging Hodgkin’s and Diffuse Large B Cell Lymphomas

Abstract

To investigate the diagnostic value of different whole-body magnetic resonance imaging (WB-MRI) protocols for staging Hodgkin and diffuse-large B-cell lymphomas (HL and DLBCL), twenty-two patients (M/F 12/10, median age 32, range 22–87, HL/DLBCL 14/8) underwent baseline WB-MRI and 18F-2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET) fused with computed tomography (CT) scan 18F-FDG-PET-CT. The 3.0 T WB-MRI was performed using pre-contrast modified Dixon (mDixon), T2-weighted turbo-spin-echo (TSE), diffusion-weighted-imaging (DWI), dynamic-contrast-enhanced (DCE) liver/spleen, contrast-enhanced (CE) lung MRI and CE whole-body mDixon. WB-MRI scans were divided into: (1) “WB-MRI DWI+IP”: whole-body DWI + in-phase mDixon (2) “WB-MRI T2-TSE”: whole-body T2-TSE (3) “WB-MRI Post-C”: whole-body CE mDixon + DCE liver/spleen and CE lung mDixon (4) “WB-MRI All “: the entire protocol. Two radiologists evaluated WB-MRIs at random, independently and then in consensus. Two nuclear-medicine-physicians reviewed 18F-FDG PET-CT in consensus. An enhanced-reference-standard (ERS) was derived using all available baseline and follow-up imaging. The sensitivity and specificity of WB-MRI protocols for nodal and extra-nodal staging was derived against the ERS. Agreement between the WB-MRI protocols and the ERS for overall staging was assessed using kappa statistic. For consensus WB-MRI, the sensitivity and specificity for nodal staging were 75%, 98% for WB-MRI DWI+IP, 76%, 98% for WB-MRI Post-C, 83%, 99% for WB-MRI T2-TSE and 87%, 100% for WB-MRI All. The sensitivity and specificity for extra-nodal staging were 67% 100% for WB-MRI DWI+IP, 89%, 100% for WB-MRI Post-C, 89%, 100% for WB-MRI T2-TSE and 100%, 100% for the WB-MRI All. The consensus WB-MRI All read had perfect agreement with the ERS for overall staging [kappa = 1.00 (95% CI: 1.00-1.00)]. The best diagnostic performance is achieved combining all available WB-MRI sequences.

The diagnostic performance of whole-body MRI in the staging of lymphomas in adult patients compared to PET/CT and enhanced reference standard—systematic review and meta-analysis

“…The most commonly used morphological sequences were the STIR followed by T2 and T1 performed under free breathing, with breath-hold or respiratory-triggered. In one study (21) only, patients were given contrast material i.v. Occasionally, special acquisitions were performed for the neck and lungs (Table 2).…”

“…Most studies (n=11) reported agreement in the principal stages, one study (22) included E and S modifiers, where present. A single study (21) that reported agreement based on the Lugano criteria, was not included. A leave-one-out sensitivity analysis is shown on Figure S10.…”

Imaging evaluation of lymphoma in pregnancy with review of clinical assessment and treatment options

“…They found that WB-MRI with diffusion-weighted imaging had a sensitivity of 94% for the detection of the aforementioned diseases, which was statistically significantly higher than the 88% sensitivity of WB-MRI without DWI [33]. The primary conclusion of the study was that "WB-MRI All," which combined all sequences, had the highest sensitivity and specificity for the assessment of lymphoma when comparing to PET-CT, by 100% [34]. Further review of this publication is beyond the scope of this manuscript; however, the study contains additional details that may be of interest to the reader.…”

Whole body MRI with Diffusion Weighted Imaging versus 18F-fluorodeoxyglucose-PET/CT in the staging of lymphomas

“…Several studies have reported significantly lower ADC values in lymphomas compared with normal lymph nodes and nodal sites of carcinoma [ 14 ]; moreover, ADC values increase after treatment in responder patients [ 15 , 16 ]. To date, however, WB-MRI is still not routinely performed in patients with lymphoma because of the absence of standardized parameters for assessing disease burden and degree of response to treatment, compared with 18F-FDG-PET/CT [ 17 ].…”