Abstract
We investigated the efficacy of pelvic magnetic resonance imaging (MRI) in the diagnosis of bone marrow involvement (BMinv) in diffuse large B-cell lymphoma (DLBCL) patients. This was a retrospective study of data from a previous study (NCT02733887). We included 171 patients who underwent bone marrow biopsy (BMB) and bone marrow smear (BMS), pelvic MRI, and whole-body positron emission tomography-computed tomography (PET/CT) from January 2016 to December 2019 at a single center. BMB/BMS and whole-body PET/CT results were used as reference standards against which we calculated the diagnostic value of pelvic MRI for BMinv in DLBCL patients. A chi-square test was used to compare detection rates, and a receiver operating characteristic curve was used to evaluate diagnostic value of pelvic MRI. Propensity-score matching was performed according to clinical information, and Kaplan-Meier curves were constructed to compare progression-free survival (PFS) and overall survival (OS) of patients. The BMinv detection rate of pelvic MRI (42/171) was higher (P = 0.029) than that of BMB/BMS (25/171), and similar to that of PET/CT (44/171; P = 0.901). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of pelvic MRI were 83.33%, 98.37%, 94.15%, 95.24%, and 93.80%, respectively. Median PFS values were as follows: BMB/BMS-positive, 17.8 months vs. BMB/BMS-negative, 26.9 months (P = 0.092); PET/CT-positive, 24.8 months vs. PET/CT-negative, 33.0 months (P = 0.086); pelvic MRI-positive, 24.9 months vs. pelvic MRI-negative, 33.1 months (P<0.001). Median OS values were as follows: BMB/BMS-positive, 22.3 months vs. BMB/BMS-negative, 29.8 months (P = 0.240); PET/CT-positive, 27.9 months vs. PET/CT-negative, 33.9 months (P = 0.365); pelvic MRI-positive, 27.3 months vs. pelvic MRI-negative, 35.8 months (P = 0.062). Pelvic MRI is effective for detecting BMinv in DLBCL patients, providing a more accurate indication of PFS than BMB/BMS and PET/CT do. It may ultimately be used to improve the accuracy of clinical staging, guide patient treatment, and evaluate prognosis.
Highlights
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma [1], and approximately 11%–34% of these patients have bone marrow involvement (BMinv) at the time of diagnosis [2]
Pelvic magnetic resonance imaging (MRI) is effective for detecting BMinv in DLBCL patients, providing a more accurate indication of progression-free survival (PFS) than bone marrow biopsy/smear (BMB/bone marrow smear (BMS)) and positron emission tomography-computed tomography (PET/computed tomography (CT)) do
We demonstrated that pelvic MRI may be an alternative, but improve the BMinv detection rate for DLBCL patients
Summary
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma [1], and approximately 11%–34% of these patients have bone marrow involvement (BMinv) at the time of diagnosis [2]. In several studies in recent years, whole-body magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET/CT) has been demonstrated to possess a higher diagnostic value than BMB in the detection of BMinv in lymphoma [9,10,11]. Both PET/CT and whole-body MRI are relatively costly, which restricts their clinical application. Pelvic MRI is an effective method to screen the pelvis, the femur, and certain vertebrae, there have been no studies to assess its value in the diagnosis of BMinv in DLBCL. We demonstrated that pelvic MRI may be an alternative, but improve the BMinv detection rate for DLBCL patients
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