Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2021 Jun;100(6):1525-1535.
doi: 10.1007/s00277-021-04537-5. Epub 2021 Apr 28.

PET/MRI for staging patients with Hodgkin lymphoma: equivalent results with PET/CT in a prospective trial

M Picardi  1 , C Cavaliere  2 , R Della Pepa  3 , E Nicolai  2 , A Soricelli  4 , C Giordano  1 , N Pugliese  1 , M G Rascato  1 , I Cappuccio  1 , G Campagna  1 , C Cerchione  1 , E Vigliar  5 , G Troncone  5 , M Mascolo  6 , M Franzese  2 , R Castaldo  2 , M Salvatore  2 , F Pane  1
Affiliations
Clinical Trial

PET/MRI for staging patients with Hodgkin lymphoma: equivalent results with PET/CT in a prospective trial

M Picardi et al. Ann Hematol. 2021 Jun.

Abstract

To compare FDG-PET/unenhanced MRI and FDG-PET/diagnostic CT in detecting infiltration in patients with newly diagnosed Hodgkin lymphoma (HL). The endpoint was equivalence between PET/MRI and PET/CT in correctly defining the revised Ann Arbor staging system. Seventy consecutive patients with classical-HL were prospectively investigated for nodal and extra-nodal involvement during pretreatment staging with same-day PET/CT and PET/MRI. Findings indicative of malignancy with the imaging procedures were regarded as lymphoma infiltration; in case of discrepancy, positive-biopsy and/or response to treatment were evidenced as lymphoma. Sixty of the 70 (86%) patients were evaluable having completed the staging program. Disease staging based on either PET/MRI or PET/CT was correct for 54 of the 60 patients (90% vs. 90%), with difference between proportions of 0.0 (95% CI, -9 to 9%; P=0.034 for the equivalence test). As compared with reference standard, invasion of lymph nodes was identified with PET/MRI in 100% and with PET/CT in 100%, of the spleen with PET/MRI in 66% and PET/CT in 55%, of the lung with PET/MRI in 60% and PET/CT in 100%, of the liver with PET/MRI in 67% and PET/CT in 100%, and of the bone with PET/MRI in 100% and PET/CT in 50%. The only statistically significant difference between PET/MRI and PET/CT was observed in bony infiltration detection rates. For PET/CT, iodinate contrast medium infusions' average was 86 mL, and exposure to ionizing radiation was estimated to be 4-fold higher than PET/MRI. PET/MRI is a promising safe new alternative in the care of patients with HL.

Keywords: Hodgkin lymphoma; PET/CT; PET/MRI.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Consort diagram. PET/MRI and PET/CT enable equivalent determination of the tumor stage. FDG-PET, 18F-fluoro-deoxy-glucose positron emission tomography; CT, computed tomography; MRI, magnetic resonance imaging; US, ultrasonography; CE-US, contrast-enhanced ultrasonography; i.v., intravenous. *Routine staging procedures: see supplemental Appendix 1
Fig. 2
Fig. 2
Revised Ann Arbor staging according to the Lugano Classification. Based on the reference standard, final disease stage was I for 8 patients (14%), II for 22 patients (37%; IIE for 2 of them), III for 11 patients (18%; IIIs for 2 of them), and IV for 19 patients (31%; IVs for 7 of them). No overrated stage was observed, owing to the stringent imaging criteria for malignant findings, i.e., positive-PET combined with positive-CT and/or positive-MRI. PET, 18F-fluoro-deoxy-glucose positron emission tomography; MRI, unenhanced magnetic resonance imaging; CT, full-dose contrast enhanced computed tomography
Fig. 3
Fig. 3
Coronal CT (a), coronal PET from PET/CT (b), fused coronal PET/CT (c), coronal STIR (d), coronal PET from PET/MRI (e), and fused coronal PET/MRI (f). FDG-avid left iliac bony lymphomatous lesion (above acetabulum; arrows) can be observed in the PET images obtained from both the PET/CT and the PET/MRI scans. However, no anatomic correlate is visible on CT, whereas it is clearly visible in the STIR image (see Supplemental Appendix Table 2 and Supplemental Appendix 3)
Fig. 4
Fig. 4
Graph depicts the diagnostic sensitivity of each imaging technique in detecting bone focal lesions involved by lymphoma according to lesion size (long axis). NS, not significant; MRI, magnetic resonance imaging; FDG-PET, 18F-fluoro-deoxy-glucose positron emission tomography; CT, computed tomography
See this image and copyright information in PMC

References

    1. Eichenauer DA, Aleman BMP, Andre M, Federico M, Hutchings M, Illidge T, Engert A, Ladetto M, clinicalguidelines@esmo.org EGCEa. Hodgkin lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018;29 Suppl 4:iv19-iv29. 10.1093/annonc/mdy080 - PubMed
    1. Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Armand P, Bello CM, Benitez CM, Bierman PJ, Boughan KM, Dabaja B, Gordon LI, Hernandez-Ilizaliturri FJ, Herrera AF, Hochberg EP, Huang J, Johnston PB, Kaminski MS, Kenkre VP, Khan N, Lynch RC, Maddocks K, McConathy J, McKinney M, Metzger M, Morgan D, Mulroney C, Rabinovitch R, Rosenspire KC, Seropian S, Tao R, Winter JN, Yahalom J, Burns JL, Ogba N, Hodgkin lymphoma NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw. 2020;18(6):755–781. doi: 10.6004/jnccn.2020.0026. - DOI - PubMed
    1. Barrington SF, Mikhaeel NG, Kostakoglu L, Meignan M, Hutchings M, Mueller SP, Schwartz LH, Zucca E, Fisher RI, Trotman J, Hoekstra OS, Hicks RJ, O’Doherty MJ, Hustinx R, Biggi A, Cheson BD. Role of imaging in the staging and response assessment of lymphoma: consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol. 2014;32(27):3048–3058. doi: 10.1200/JCO.2013.53.5229. - DOI - PMC - PubMed
    1. Cheson BD, Fisher RI, Barrington SF, Cavalli F, Schwartz LH, Zucca E, Lister TA, Alliance AL, Lymphoma G, Eastern Cooperative Oncology G. European Mantle Cell Lymphoma C. Italian Lymphoma F. European Organisation for R. Treatment of Cancer/Dutch Hemato-Oncology G. Grupo Espanol de Medula O. German High-Grade Lymphoma Study G. German Hodgkin’s Study G. Japanese Lymphorra Study G. Lymphoma Study A. Group NCT. Nordic Lymphoma Study G. Southwest Oncology G. United Kingdom National Cancer Research I Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014;32(27):3059–3068. doi: 10.1200/JCO.2013.54.8800. - DOI - PMC - PubMed
    1. Budano C, Levis M, D’Amico M, Usmiani T, Fava A, Sbarra P, Burdese M, Segoloni GP, Colombo A, Marra S. Impact of contrast-induced acute kidney injury definition on clinical outcomes. Am Heart J. 2011;161(5):963–971. doi: 10.1016/j.ahj.2011.02.004. - DOI - PubMed

Publication types

Substances