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Comparative Study
. 2015 Dec 23:15:1002.
doi: 10.1186/s12885-015-2009-z.

Diagnostic performance of FDG-PET/MRI and WB-DW-MRI in the evaluation of lymphoma: a prospective comparison to standard FDG-PET/CT

Ken Herrmann  1   2 , Marcelo Queiroz  3 , Martin W Huellner  4   5   6 , Felipe de Galiza Barbosa  7 , Andreas Buck  8 , Niklaus Schaefer  9   10   11 , Paul Stolzman  12   13   14 , Patrick Veit-Haibach  15   16   17
Affiliations
Comparative Study

Diagnostic performance of FDG-PET/MRI and WB-DW-MRI in the evaluation of lymphoma: a prospective comparison to standard FDG-PET/CT

Ken Herrmann et al. BMC Cancer. .

Abstract

Background: Use of FDG-PET/CT for staging and restaging of lymphoma patients is widely incorporated into current practice guidelines. Our aim was to prospectively evaluate the diagnostic performance of FDG-PET/MRI and WB-DW-MRI compared with FDG-FDG-PET/CT using a tri-modality PET/CT-MRI system.

Methods: From 04/12 to 01/14, a total of 82 FDG-PET/CT examinations including an additional scientific MRI on a tri-modality setup were performed in 61 patients. FDG-PET/CT, FDG-PET/MRI, and WB-DW-MRI were independently analyzed. A lesion with a mean ADC below a threshold of 1.2 × 10(-3) mm(2)/s was defined as positive for restricted diffusion. FDG-PET/CT and FDG-PET/MRI were evaluated for the detection of lesions corresponding to lymphoma manifestations according to the German Hodgkin Study Group. Imaging findings were validated by biopsy (n = 21), by follow-up imaging comprising CT, FDG-PET/CT, and/or FDG-PET/MRI (n = 32), or clinically (n = 25) (mean follow-up: 9.1 months).

Results: FDG-PET/MRI and FDG-PET/CT accurately detected 188 lesions in 27 patients. Another 54 examinations in 35 patients were negative. WB-DW-MRI detected 524 lesions, of which 125 (66.5% of the aforementioned 188 lesions) were true positive. Among the 188 lesions positive for lymphoma, FDG-PET/MRI detected all 170 instances of nodal disease and also all 18 extranodal lymphoma manifestations; by comparison, WB-DW-MRI characterized 115 (67.6%) and 10 (55.6%) lesions as positive for nodal and extranodal disease, respectively. FDG-PET/MRI was superior to WB-DW-MRI in detecting lymphoma manifestations in patients included for staging (113 vs. 73), for restaging (75 vs. 52), for evaluation of high- (127 vs. 81) and low-grade lymphomas (61 vs. 46), and for definition of Ann Arbor stage (WB-DW-MRI resulted in upstaging in 60 cases, including 45 patients free of disease, and downstaging in 4).

Conclusion: Our results indicate that FDG-PET/CT and FDG-PET/MRI probably have a similar performance in the clinical work-up of lymphomas. The performance of WB-DW-MRI was generally inferior to that of both FDG-PET-based methods but the technique might be used in specific scenarios, e.g., in low-grade lymphomas and during surveillance.

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Figures

Fig. 1
Fig. 1
A male patient with Hodgkin’s disease stage IIIE. PET/CT/MRI after two cycles of chemotherapy. Top: Axial PET shows very faint uptake in the anterior mediastinal lesion; axial WB-DW-MRI (b value = 800) shows restricted diffusion (calculated ADCmean = 0.96 × 10−3 mm2/s). Bottom: FDG-PET/CT and FDG-PET/MRI show a residual mediastinal mass without significant FDG activity. FDG-PET/CT and FDG-PET/MRI after the end of treatment confirmed complete response
Fig. 2
Fig. 2
A female patient with a diffuse large B-cell lymphoma stage IVB. PET/CT/MRI for initial staging. Top: Axial WB-DW-MRI (b value = 800) and axial ADC map show restricted diffusion in a lymph node conglomerate in the upper abdomen (calculated ADCmean = 0.72 × 10−3 mm2/s), but no restricted diffusion in the spleen (calculated ADCmean = 1.37 × 10−3 mm2/s). Axial PET shows uptake in the same lymph node conglomerate but also diffuse uptake in the spleen, which was significantly higher than liver uptake. Bottom: FDG-PET/CT and FDG-PET/MRI show FDG avidity in both the lymph node mass and the spleen, indicating lymphoma manifestation
See this image and copyright information in PMC

References

    1. Cheson BD, Fisher RI, Barrington SF, Cavalli F, Schwartz LH, Zucca E, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and Non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014;32:3059–68. doi: 10.1200/JCO.2013.54.8800. - DOI - PMC - PubMed
    1. Koh D-M, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. Am J Roentgenol. 2007;188:1622–35. doi: 10.2214/AJR.06.1403. - DOI - PubMed
    1. Kwee TC, Vermoolen MA, Akkerman EA, Kersten MJ, Fijnheer R, Ludwig I, et al. Whole-body MRI, including diffusion-weighted imaging, for staging lymphoma: comparison with CT in a prospective multicenter study. J Magn Reson Imaging. 2014;40:26–36. doi: 10.1002/jmri.24356. - DOI - PubMed
    1. Lin C, Luciani A, Itti E, El-Gnaoui T, Vignaud A, Beaussart P, et al. Whole-body diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient mapping for staging patients with diffuse large B-cell lymphoma. Eur Radiol. 2010;20:2027–38. doi: 10.1007/s00330-010-1758-y. - DOI - PubMed
    1. Van Ufford HMEQ, Kwee TC, Beek FJ, van Leeuwen MS, Takahara T, Fijnheer R, et al. Newly diagnosed lymphoma: initial results with whole-body T1-weighted, STIR, and diffusion-weighted MRI compared with 18F-FDG PET/CT. AJR Am J Roentgenol. 2011;196:662–9. doi: 10.2214/AJR.10.4743. - DOI - PubMed

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