Initial experience with FSE STIR whole-body MR imaging for staging lymphoma in children

Abstract

Our objective was to compare fast spin-echo (FSE) short inversion time inversion recovery (STIR) whole-body MR imaging with standard procedures in staging children with lymphoma. Eight children (age range, 2-16 years) underwent multi-station FSE STIR whole-body MR at initial staging (n=5) or for restaging following completion of therapy (n=5). Whole-body MR and conventional staging procedures, including CT (n=10), gallium-67 scintigraphy (n=9), bone scintigraphy (n=3) and bone marrow biopsy (n=7) were retrospectively compared for detection of sites involved by lymphoma and for the assigned stage. FSE STIR whole-body MR detected more sites of possible lymphomatous involvement at initial staging (87/88) and at restaging (5/5) than did conventional imaging (74/88, 3/5). MR was more sensitive than conventional imaging in detecting bone marrow involvement at initial staging. Following treatment, however, residual and therapy-induced bone marrow signal abnormalities could not be differentiated from lymphomatous involvement. Detection of nodal and visceral involvement correlated well. Our results suggest that FSE STIR whole-body MR imaging is a sensitive technique for evaluating lymphomatous involvement of bone marrow as well as non-marrow sites. Larger prospective trials are needed to determine if FSE STIR whole-body MR can replace standard radiographic procedures for initial staging and contribute in the follow-up of lymphoma in children.

Diagnostic value of whole‐body magnetic resonance imaging for bone metastases: a systematic review and meta‐analysis

“…Several reports have shown whole-body MRI to be highly sensitive and accurate for the evaluation of metastasis (8)(9)(10)(11)(12)(13). The combination of noncontrasted T1-weighted spinecho (SE) sequences and fat-suppressed short tau inversion recovery (STIR) imaging proved to be the most accurate in the detection of malignant bone marrow disorders and an excellent negative and positive predictive value, especially for STIR imaging, has been described in the literature (8,9,(14)(15)(16). Additionally, MRI enables precise assessment of the tumor extent within the bone marrow and into paraosseus structures, such as the spinal canal.…”

Whole-Body MR Imaging for Staging of Malignant Tumors in Pediatric Patients: Results of the American College of Radiology Imaging Network 6660 Trial

“…The results of several studies have shown that whole-body MR imaging allows for more accurate detection of skeletal and extraskeletal metastases in children than does conventional oncologic imaging (16)(17)(18)(19)(20)(21)(22)27,28). These studies were limited by inclusion of patients from a single site, small sample sizes, inclusion of patients with prior treatment, and nonuniformity of the experimental or reference standard imaging.…”

Whole Body MRI and Diffusion Weighed Images in Pediatric Oncology: Lymphomas and Several Others Tumors

“…A number of different studies [14][15][16][17][18][19][20][21] evaluated several MRI sequences, and only the inversion recovery, such as STIR (Short Tau Inversion Recovery) were in unanimity among their protocols, as it is sensitive to diseases when compared to other sequences [14,15], and exhibits image properties of a mix of proton density, T1, T2 with inherent fat suppression [22] (Fig. 2).…”

“…Staging both Hodgkin and non-Hodgkin lymphoma involves the search for bone marrow involvement present at up to 16 % of whose that can be missed at plain radiography [42]. WB-MRI has proved to be more sensitive than scintigraphy detecting both marrow and nonmarrow involvement [17] and can be a very good alternative to patients who cannot undergo a PET-CT [43] during its important staging because even the iliac crest blind biopsy can be negative reflecting the patchy bone marrow involvement pattern [44] (Fig. 6).…”