Abstract
(1) Background: The purpose of this study is to retrospectively compare CT, MRI, and PET/CT in detecting lymphadenopathies and extra-nodal lesions in lymphoma and in disease staging. (2) Methods: Inclusion criteria were the availability of TB (Total Body) CT and/or PET/CT performed before treatment; MRI performed no later than 2 weeks after TBCT; histological confirmation of lymphoma; clinical-diagnostic follow-up. Using these criteria, we included 64/353 patients with TBCT and MRI performed at our hospital; 20/64 had PET/CT performed in other hospitals. Histology and follow-up were gold standard. (3) Results: The sensitivity, specificity, and accuracy in lymph nodes detection was 84.5%, 94.4%, and 91% for CT and 95%, 98.9%, and 95.6% for MRI. High agreement was observed between CT and MRI regarding the number and size of positive lymph nodes and for disease staging. MRI identified eight more extra-nodal lesions than CT. In the subgroup of 20 patients, PET/CT did not show a significant superiority in sensitivity, specificity, accuracy, and staging ability than CT and MRI. (4) Conclusions: Our study demonstrates a mild superiority of MRI over CT in lymphoma staging. Although PET/CT remains the reference standard, MRI demonstrated a similar diagnostic accuracy, with the added value of being radiation-free.
Highlights
Lymphomas include a wide spectrum of pathologies with heterogeneous clinical manifestations and localizations, with more than 50 subtypes, which differ in terms of molecular and genetic characteristics, histocytopathology, response to pharmacological treatment, and autologous transplantation, as well as for prognosis [1]
Compared to positron emission tomography (PET)/CT and MRI, CT has a reduced overall sensitivity, since it cannot provide functional or metabolic information regarding the activity of lymph nodes or extra nodal localizations of disease [5,6,7]
The most recent guidelines (Lugano classification) recommend a 15 mm largest diameter cut-off to consider a lymph node as pathological and 10 mm diameter for extra-nodal lesions. This does not exclude the possibility that smaller lymph nodes may be affected by disease, which is a phenomenon that can be recognized in subsequent CT exams only, if lesions grow in size, or that larger lymph nodes may be inflammatory and disease free, if unchanged at follow up [8]
Summary
Lymphomas include a wide spectrum of pathologies with heterogeneous clinical manifestations and localizations, with more than 50 subtypes, which differ in terms of molecular and genetic characteristics, histocytopathology, response to pharmacological treatment, and autologous transplantation, as well as for prognosis [1]. The most recent guidelines (Lugano classification) recommend a 15 mm largest diameter cut-off to consider a lymph node as pathological and 10 mm diameter for extra-nodal lesions This does not exclude the possibility that smaller lymph nodes may be affected by disease, which is a phenomenon that can be recognized in subsequent CT exams only, if lesions grow in size, or that larger lymph nodes may be inflammatory and disease free, if unchanged at follow up [8]. CT has a low sensitivity for determining the extent of bone marrow disease [9]
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