Assessment of naive indolent lymphoma using whole-body diffusion-weighted imaging and T2-weighted MRI: results of a prospective study in 30 patients

Gil-Sun Hong,Hyo Sang Lee,Cheolwon Suh,Eun Jin Chae,Dok Hyun Yoon,Sun Young Chae,Jin-Sook Ryu

doi:10.1186/s40644-020-00371-6

Gil-Sun Hong, Hyo Sang Lee + Show 5 more

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https://doi.org/10.1186/s40644-020-00371-6

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Abstract

BackgroundWe prospectively evaluated the diagnostic utility of whole-body diffusion-weighted imaging with background body signal suppression and T2-weighted short-tau inversion recovery MRI (WB-DWIBS/STIR) for the pretherapeutic staging of indolent lymphoma in 30 patients.MethodsThis prospective study included 30 treatment-naive patients with indolent lymphomas who underwent WB-DWIBS/STIR and conventional imaging workup plus biopsy. The pretherapeutic staging agreement, sensitivity, and specificity of WB-DWIBS/STIR were investigated with reference to the multimodality and multidisciplinary consensus review for nodal and extranodal lesions excluding bone marrow.ResultsIn the pretherapeutic staging, WB-DWIBS/STIR showed very good agreement (κ = 0.96; confidence interval [CI], 0.88–1.00), high sensitivity (93.4–95.1%), and high specificity (99.0–99.4%) for the whole-body regions. These results were similar to those of 18F-FDG-PET/CT, except for the sensitivity for extranodal lesions. For extranodal lesions, WB-DWIBS/STIR showed higher sensitivity compared to 18F-FDG-PET/CT for the whole-body regions (94.9–96.8% vs. 79.6–86.3%, P = 0.058).ConclusionWB-DWIBS/STIR is an effective modality for the pretherapeutic staging of indolent lymphoma, and it has benefits when evaluating extranodal lesions, compared with 18F-FDG-PET/CT.

Highlights

We prospectively evaluated the diagnostic utility of whole-body diffusion-weighted imaging with background body signal suppression and T2-weighted short-tau inversion recovery MRI (WB-DWIBS/STIR) for the pretherapeutic staging of indolent lymphoma in 30 patients
WB-DWIBS/STIR is an effective modality for the pretherapeutic staging of indolent lymphoma, and it has benefits when evaluating extranodal lesions, compared with 18F-FDG-PET/CT
Full list of author information is available at the end of the article initial staging followed by strict monitoring using imaging examinations [1]. 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) has only a limited role for the non-FDG-avid subtype of lymphoma, as it is based on increased glucose metabolism

Summary

Introduction

We prospectively evaluated the diagnostic utility of whole-body diffusion-weighted imaging with background body signal suppression and T2-weighted short-tau inversion recovery MRI (WB-DWIBS/STIR) for the pretherapeutic staging of indolent lymphoma in 30 patients. The “watchful waiting” strategy has become a treatment option in indolent non-Hodgkin’s lymphoma, considering its indolent clinical behavior with a prolonged natural history. Full list of author information is available at the end of the article initial staging followed by strict monitoring using imaging examinations [1]. 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) has only a limited role for the non-FDG-avid subtype of lymphoma, as it is based on increased glucose metabolism. In clinical practice, many physicians use 18FFDG-PET/CT as the standard imaging modality for the staging of indolent lymphoma and evaluation of FDG-avid lymphoma. CT has been recommended for the monitoring and imaging follow-up of non-FDG-avid. The use of contrast agents is limited in patients with abnormal kidney function [7]

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