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.

Arash Latifoltojar,Kirit M Ardeshna,Harbir Sidhu,Deena Neriman,Alan Bainbridge,Maria Klusmann,Jonathan Lambert,Francesco Fraioli,Shonit Punwani,Mark K J Duncan

doi:10.3390/jpm10040284

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.

Highlights

Lymphomas, including Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL), are estimated to account for 3–4% of cancers worldwide [1]
We aim to prospectively evaluate the diagnostic performance of differing 3.0 T whole-body magnetic resonance imaging (MRI) (WB-MRI) protocols (comprising combinations of whole body T1 and T2 weighted imaging, DWI and contrast-enhanced (CE) imaging) for initial staging of adult HL and diffuse large B-cell lymphoma (DLBCL, the commonest subtype of NHL) against an enhanced reference standard based on 18F-FDG positron emission tomography (PET)-computed tomography (CT) and follow-up imaging
Five patients were excluded from the analysis; 1 had 18F-FDG PET-MRI, 1 only had whole-body CT scan, 1 did not initially consent to any imaging with radiation exposure and 2 did not have the 18F-FDG PET-CT images available for comparison

Summary

Introduction

Lymphomas, including Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL), are estimated to account for 3–4% of cancers worldwide [1]. Staging in HL and NHL is predominantly based on the current Lugano classification [2] taking into account the number of involved sites, the type of lesions (nodal or extra-nodal), and the distribution of disease. 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. 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]

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