Abstract
ObjectivesTo compare WB-MRI with an [18F]FDG-PET/CT-based reference for early response assessment and restaging in children with Hodgkin’s lymphoma (HL).MethodsFifty-one children (ages 10–17) with HL were included in this prospective, multicentre study. All participants underwent WB-MRI and [18F]FDG-PET/CT at early response assessment. Thirteen of the 51 patients also underwent both WB-MRI and [18F]FDG-PET/CT at restaging. Two radiologists independently evaluated all WB-MR images in two separate readings: without and with DWI. The [18F]FDG-PET/CT examinations were evaluated by a nuclear medicine physician. An expert panel assessed all discrepancies between WB-MRI and [18F]FDG-PET/CT to derive the [18F]FDG-PET/CT-based reference standard. Inter-observer agreement for WB-MRI was calculated using kappa statistics. Concordance, PPV, NPV, sensitivity and specificity for a correct assessment of the response between WB-MRI and the reference standard were calculated for both nodal and extra-nodal disease presence and total response evaluation.ResultsInter-observer agreement of WB-MRI including DWI between both readers was moderate (κ 0.46–0.60). For early response assessment, WB-MRI DWI agreed with the reference standard in 33/51 patients (65%, 95% CI 51–77%) versus 15/51 (29%, 95% CI 19–43%) for WB-MRI without DWI. For restaging, WB-MRI including DWI agreed with the reference standard in 9/13 patients (69%, 95% CI 42–87%) versus 5/13 patients (38%, 95% CI 18–64%) for WB-MRI without DWI.ConclusionsThe addition of DWI to the WB-MRI protocol in early response assessment and restaging of paediatric HL improved agreement with the [18F]FDG-PET/CT-based reference standard. However, WB-MRI remained discordant in 30% of the patients compared to standard imaging for assessing residual disease presence.Key Points• Inter-observer agreement of WB-MRI including DWI between both readers was moderate for (early) response assessment of paediatric Hodgkin’s lymphoma.• The addition of DWI to the WB-MRI protocol in early response assessment and restaging of paediatric Hodgkin’s lymphoma improved agreement with the [18F]FDG-PET/CT-based reference standard.• WB-MRI including DWI agreed with the reference standard in respectively 65% and 69% of the patients for early response assessment and restaging.
Highlights
Paediatric Hodgkin’s lymphoma is nowadays a highly curable malignancy and it is the most common type of cancer in adolescents [1, 2]
Whole-body magnetic resonance imaging (WB-MRI) including diffusion-weighted imaging (DWI) agreed with the reference standard in respectively 65% and 69% of the patients for early response assessment and restaging
It is shown in the literature that children as compared to adults have an increased vulnerability to the long-term side effects of ionizing radiation such as secondary malignancies [5,6,7,8]
Summary
Paediatric Hodgkin’s lymphoma is nowadays a highly curable malignancy and it is the most common type of cancer in adolescents [1, 2]. In between the initial diagnosis and end of treatment, children diagnosed with Hodgkin’s lymphoma undergo multiple imaging examinations and are exposed to a substantial dose of ionizing radiation. It is shown in the literature that children as compared to adults have an increased vulnerability to the long-term side effects of ionizing radiation such as secondary malignancies [5,6,7,8]. This underlines the need for careful administration of ionizing radiation in childhood, both for therapy purposes and in diagnostic imaging protocols
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