Whole-body MRI versus ¹⁸F-FDG PET/CT for pretherapeutic assessment and staging of lymphoma: a meta-analysis

Abstract

Purpose18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is the reference standard in staging of 18F-FDG-avid lymphomas; however, there is no recommended functional imaging modality for indolent lymphomas. Therefore, we aimed to compare the performance of whole-body magnetic resonance imaging (WB-MRI) with that of 18F-FDG PET/CT for lesion detection and initial staging in patients with aggressive or indolent lymphoma.Materials and methodsWe searched the MEDLINE, EMBASE, and CENTRAL databases for studies that compared WB-MRI with 18F-FDG PET/CT for lymphoma staging or lesion detection. The methodological quality of the studies was assessed using version 2 of the “Quality Assessment of Diagnostic Accuracy Studies” tool. The pooled staging accuracy (μ) of WB-MRI and 18F-FDG PET/CT for initial staging and for assessing possible heterogeneity (χ2) across studies were calculated using commercially available software.ResultsEight studies comprising 338 patients were included. In terms of staging, the meta-analytic staging accuracies of WB-MRI and 18F-FDG PET/CT for Hodgkin lymphoma and aggressive non-Hodgkin lymphoma (NHL) were 98% (95% CI, 94%–100%) and 98% (95% CI, 94%–100%), respectively. The pooled staging accuracy of 18F-FDG PET/CT dropped to 87% (95% CI, 72%–97%) for staging in patients with indolent lymphoma, whereas that of WB-MRI remained 96% (95% CI, 91%–100%). Subgroup analysis indicated an even lower staging accuracy of 18F-FDG PET/CT for staging of less FDG-avid indolent NHLs (60%; 95% CI, 23%–92%), in contrast to the superior performance of WB-MRI (98%; 95% CI, 88%–100%).ConclusionWB-MRI is a promising radiation-free imaging technique that may serve as a viable alternative to 18F-FDG PET/CT for staging of 18FDG-avid lymphomas, where 18F-FDG PET/CT remains the standard of care. Additionally, WB-MRI seems a less histology-dependent functional imaging test than 18F-FDG PET/CT and may be the imaging test of choice for staging of indolent NHLs with low 18F-FDG avidity.

Whole‐body magnetic resonance imaging (WB‐MRI) in lymphoma: State of the art

“…In literature, excellent agreement ( k = 0.82‐1.00) between WB‐MRI and 18 F‐FDG‐PET/CT has been reported for the detection of both nodal and extranodal locations . WB‐MRI at 1.5 and 3T scanner have shown similar diagnostic performance for lymphoma staging .…”

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

“…Stecco et al reported an 85% accuracy of WB-MRI for staging gastrointestinal lymphomas among 17 patients with lymphoma (including 13 indolent lymphomas); they also demonstrated excellent agreement between WB-MRI and 18 F-FDG-PET/CT [ 32 ]. In a meta-analysis for the staging accuracy of WB-MRI for indolent lymphomas, the pooled staging accuracy of WB-MRI was 96%, whereas that of 18 F-FDG-PET/CT was 87% [ 33 ]. The high staging accuracy of WB-MRI in our study is consistent with the findings of Mayerhoefer et al and the meta-analysis.…”

Detection and Characterization of Musculoskeletal Cancer Using Whole-Body Magnetic Resonance Imaging

“…WB-MRI outperforms PET/ CT in certain subtypes of lymphoma including peripheral Tcell lymphomas, indolent lymphomas, and lesions < 5 mm, as well as in patients presenting with a high extranodal disease load, because it allows for better evaluation of skeletal lesions including fracture risk assessments. 70,[72][73][74] Detection and Characterizations of Primary Skeletal Tumors…”