Assessment of naive indolent lymphoma using whole-body diffusion-weighted imaging and T2-weighted MRI: results of a prospective study in 30 patients

Abstract

Background We prospectively evaluated the diagnostic utility of whole-body diffusion-weighted imaging with background body signal suppression and T2-weighted short-tau inversion recovery MRI (WB-DWIBS/STIR) for the pretherapeutic staging of indolent lymphoma in 30 patients. Methods This prospective study included 30 treatment-naive patients with indolent lymphomas who underwent WB-DWIBS/STIR and conventional imaging workup plus biopsy. The pretherapeutic staging agreement, sensitivity, and specificity of WB-DWIBS/STIR were investigated with reference to the multimodality and multidisciplinary consensus review for nodal and extranodal lesions excluding bone marrow. Results In the pretherapeutic staging, WB-DWIBS/STIR showed very good agreement (κ = 0.96; confidence interval [CI], 0.88–1.00), high sensitivity (93.4–95.1%), and high specificity (99.0–99.4%) for the whole-body regions. These results were similar to those of 18F-FDG-PET/CT, except for the sensitivity for extranodal lesions. For extranodal lesions, WB-DWIBS/STIR showed higher sensitivity compared to 18F-FDG-PET/CT for the whole-body regions (94.9–96.8% vs. 79.6–86.3%, P = 0.058). Conclusion WB-DWIBS/STIR is an effective modality for the pretherapeutic staging of indolent lymphoma, and it has benefits when evaluating extranodal lesions, compared with 18F-FDG-PET/CT.

The diagnostic performance of whole-body MRI in the staging of lymphomas in adult patients compared to PET/CT and enhanced reference standard—systematic review and meta-analysis

“…Funnel plot and Egger's test did not indicate asymmetry of the distribution of results among studies (P=0.75, Figure S9). Most studies (n=11) reported agreement in the principal stages, one study (22) included E and S modifiers, where present. A single study (21) that reported agreement based on the Lugano criteria, was not included.…”

“…All wbMRI studies acquired at least two b values. The acquisition was performed in the transverse plane except for one study (22), which acquired head and neck in the transverse plane and the rest of the body in the coronal plane. Two studies (7,11) used respiratory triggering for DWI.…”

MRI versus CT and PET/CT in the Preoperative Assessment of Hodgkin and Non-Hodgkin Lymphomas

“…Recently, Whole Body Diffusion MRI (WB-DW MRI) has been proposed as a possible alternative to PET/CT [25,26]. It has also been demonstrated that WB-DW MRI is less histology dependent than PET/CT and thus is likely to become the imaging test of choice for staging indolent lymphomas with low FDG avidity in a short time frame [27][28][29].…”