Whole-body MRI with diffusion-weighted imaging: a valuable alternative to contrast-enhanced CT for initial staging of aggressive lymphoma.

Abstract

AIM:

To compare the accuracy of whole-body magnetic resonance imaging (Wb-MRI) with diffusion-weighted imaging (DWI) to that of contrast-enhanced computed tomography (CE-CT) and 2-[(18)F]-fluoro-2-deoxy-d-glucose ((18)F-FDG) positron-emission tomography co-registered with low dose-CT (PET-CT) in defining lymphoma disease stage.

MATERIALS AND METHODS:

From February 2010 to May 2014, 41 lymphoma patients underwent Wb-MRI-DWI, CE-CT, and (18)F-FDG PET-CT. Histological subtypes included aggressive B-cell (n=11), follicular (n=13), mantle cell (n=3), and Hodgkin's (n=14) lymphoma. To compare the procedures, the reference standard (RS) assessment was defined by combining the results from (18)F-FDG PET-CT, CE-CT, and bone marrow (BM) histology, modifications after therapy, and histological re-assessments of uncertain lesions.

RESULTS:

Among 1025 nodal sites, 217 had disease involvement according to the RS. CE-CT yielded 23 false-negative and 11 false-positive errors. Wb-MRI-DWI failed to recognise 17 localisations and had six false-positive errors; (18)F-FDG PET-CT had no errors. Among 458 extranodal sites, 37 were positive according to the RS. (18)F-FDG PET-CT yielded four false-negative and two false-positive results. CE-CT yielded 17 false-negative errors. Wb-MRI-DWI yielded a single false-negative error. Wb-MRI-DWI was the most reliable imaging technique for BM evaluation. Considering each procedure alone, the final stage would have been missed in four cases using (18)F-FDG PET-CT, 12 cases using CE-CT, and none using Wb-MRI-DWI.

CONCLUSION:

The present data support Wb-MRI-DWI as a sensitive and specific imaging technique for lymphoma evaluation, supporting its use in place of CE-CT for staging.

• Authors: A Balbo-Mussetto, S Cirillo, R Bruna, A Gueli, C Saviolo, M Petracchini, A Fornari, C V Lario, D Gottardi, A De Crescenzo, C Tarella
• Journal: Clinical radiology (Clin Radiol) Vol. 71 Issue 3 Pg. 271-9 (Mar 2016) ISSN: 1365-229X [Electronic] England
• PMID: 26749081 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Contrast Media
• Fluorodeoxyglucose F18
• Iohexol
• iopromide

Topics

• Adult
• Aged
• Biopsy
• Contrast Media
• Diagnosis, Differential
• Diffusion Magnetic Resonance Imaging (methods)
• Female
• Fluorodeoxyglucose F18
• Humans
• Image Interpretation, Computer-Assisted
• Iohexol (analogs & derivatives)
• Lymphoma (diagnosis, diagnostic imaging, pathology)
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Multimodal Imaging
• Neoplasm Staging
• Positron-Emission Tomography
• Retrospective Studies
• Sensitivity and Specificity
• Tomography, X-Ray Computed
• Whole Body Imaging (methods)