Whole-body magnetic resonance imaging in paediatric Hodgkin lymphoma — evaluation of quantitative magnetic resonance metrics for nodal staging

Abstract

Background Whole-body MRI is used for staging paediatric Hodgkin lymphoma, commonly using size thresholds, which fail to detect disease in normal-size lymph nodes. Objective To investigate quantitative whole-body MRI metrics for nodal characterisation. Materials and methods Thirty-seven children with Hodgkin lymphoma underwent 1.5-tesla (T) whole-body MRI using short tau inversion recovery (STIR) half-Fourier-acquisition single-shot turbo-spin-echo and diffusion-weighted imaging (DWI). 18 Flourine-2-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET)/CT was acquired as the reference standard. Two independent readers assessed 11 nodal sites. The readers measured short-axis-diameter, apparent diffusion coefficient, (ADC) and normalised T2-signal intensity of the largest lymph node at each site. We used receiver operating characteristics (ROC)/area-under-the-curve (AUC) analysis for each MRI metric and derived sensitivity and specificity for nodes with short-axis diameter ≥10 mm. Sub-analysis of sensitivity and specificity was performed with application of ADC cut-off values (<0.77, <1.15 and <1.79×10 −3 mm 2 s −1 ) to 5- to 9-mm nodes. Results ROC/AUC values for reader 1/reader 2 were 0.80/0.80 and 0.81/0.81 for short-axis-diameter measured using DWI and STIR half-Fourier-acquisition single-shot turbo spin echo, respectively; 0.67/0.72 for normalised T2 signal intensity and 0.74/0.67 for ADC. Sensitivity and specificity for a short-axis diameter ≥10 mm were 84.2% and 66.7% for Reader 1 and 82.9% and 68.9% for Reader 2. Applying a short-axis-diameter ≥10-mm threshold followed by ADC cut-offs to normal-size 5- to 9-mm nodes resulted in sensitivity and specificity for Reader 1 of 88.8% and 60%, 92.1% and 56.7%, and 100% and 16.7%; and for Reader 2, 86.1% and 67.2%, 95.3% and 65.6%, and 100% and 19.7%; and ADC thresholds of <0.77, <1.15, and <1.79×10 −3 mm 2 s −1 , respectively. Conclusion Nodal size measurement provides the best single classifier for nodal disease status in paediatric Hodgkin lymphoma. Combined short-axis diameter and ADC thresholds marginally improve sensitivity and drop specificity compared with size classification alone.

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

“…For instance, health economy analysis has shown that for staging lung cancers, there is approximately 50% cost reduction for WB-MRI staging compared to standard staging pathway (including PET-CT) [ 24 ]. However, the majority of the published work either used a single morphological/functional sequence [ 22 ] or investigated the sequential added value of multiple sequences [ 10 , 12 , 15 ] as part of the WB-MRI protocol. Rarely in the literature has the diagnostic yield of each sequence been investigated separately for the evaluation of the same subject.…”

“…Finally, we were unable to obtain histological samples from all suspicious disease sites, as this would not be ethically and/or technically feasible, therefore we used an expert consensus panel and follow-up to derive an enhanced reference standard. Whilst such an approach is imperfect, it is often necessary for diagnostic accuracy studies [ 7 , 10 , 15 , 20 ].…”

“…The more wide-spread availability of magnetic resonance imaging (MRI), coupled with numerous advances in software and hardware developments, makes it a useful technique for studying a range of diseases, including various types of malignancies. Over the past decade, whole-body MRI (WB-MRI) has been developed and investigated as an alternative radiation-free imaging technique and its feasibility has been demonstrated for a range of malignancies including lymphoma [ 7 , 8 , 9 , 10 , 11 ].…”

PET/MRI Improves Management of Children with Cancer

“…A suggested SUV max cutoff for benign lymph nodes was less than 3.2. Diffusion-weighted imaging is helpful for identification of lymph nodes, although it does not outperform size criteria for characterization of malignant nodes (10)(11)(12).…”

Detection and Characterization of Musculoskeletal Cancer Using Whole-Body Magnetic Resonance Imaging

“…WB-MRI outperforms PET/ CT in certain subtypes of lymphoma including peripheral Tcell lymphomas, indolent lymphomas, and lesions < 5 mm, as well as in patients presenting with a high extranodal disease load, because it allows for better evaluation of skeletal lesions including fracture risk assessments. 70,[72][73][74] Detection and Characterizations of Primary Skeletal Tumors…”