Whole-Body Magnetic Resonance Imaging: Current Role in Patients with Lymphoma

Abstract

Imaging of lymphoma is based on the use of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) and/or contrast-enhanced CT, but concerns have been raised regarding radiation exposure related to imaging scans in patients with cancer, and its association with increased risk of secondary tumors in patients with lymphoma has been established. To date, lymphoproliferative disorders are among the most common indications to perform whole-body magnetic resonance imaging (MRI). Whole-body MRI is superior to contrast-enhanced CT for staging the disease, also being less dependent on histology if compared to ¹⁸F-FDG-PET/CT. As well, it does not require exposure to ionizing radiation and could be used for the surveillance of lymphoma. The current role of whole-body MRI in the diagnostic workup in lymphoma is examined in the present review along with the diagnostic performance in staging, response assessment and surveillance of different lymphoma subtypes.

Keywords: diffusion-weighted imaging; lymphoma; magnetic resonance imaging; staging; whole-body imaging.

Figure 1

Whole-body MRI of a 28-year-old man with Hodgkin Lymphoma. Coronal maximum intensity projection (MIP) b = 800 diffusion-weighted imaging (DWI) (a), axial b 800 DWI images of the chest (b,c), and axial ADC maps of the chest (d,e), show a lung location in the apical segment of the upper lobe of the right lung (curved arrow in (a); arrow in (b,d)) and multiple nodal locations at internal mammary level (arrow in (a); curved arrow in (c,e)).

Figure 2

Whole-body MRI of a 65-year-old man with peripheral T-cell lymphoma. Coronal short tau inversion recovery (STIR) (a), maximum intensity projection (MIP) b 800 diffusion-weighted imaging (DWI) (b), axial b 800 DWI (c,d), and axial 3D GRE T1 weighted images after intravenous contrast media injection (e,f) show multiple extranodal locations in the left palatine tonsil (void arrows in (c,e)), in the right kidney (white arrows in (d,f)) and in the bone marrow (curved arrows in (a,b,d)).

Figure 3

Whole-body MRI and contrast enhanced CT after chemotherapy treatment of a 46-year-old man with Follicular Lymphoma. Coronal T1-weighted (a); coronal short tau inversion recovery (STIR) (b); coronal MPR CT portal phase(c); axial b800 DWIBS (d); axial b50 DWIBS (e). Note residual mass in mesenteric site (arrows) without signal restriction in DWI (d,e).

Figure 4

Whole-body MRI of a 62-year-old man with pleural non-Hodgkin Mantle Cell Lymphoma. Pre-treatment coronal short tau inversion recovery (STIR) (a), maximum intensity projection (MIP) b 800 grey-scale inverted DWI (b); post-treatment coronal STIR (c); and MIP b 800 grey-scale inverted DWI (d). Pre-treatment images show multiple pleural (white arrow in (a,b)) and nodal (black arrow in (b)) locations of disease with complete response after treatment (c,d); also note the presence of pleural effusion (* in (a)), and a vertebral hemangioma with no changes after chemotherapy (curved arrow in (b–d)).

Figure 5

Whole-body MRI of a 36-year-old woman with non-Hodgkin diffuse B-cell lymphoma, treated with six courses of DA-REPOCH. Pre-treatment coronal T1-weighted (a); pre-treatment coronal short tau inversion recovery (STIR) (b); pre-treatment maximum intensity projection (MIP) b 800 grey-scale inverted DWI (c); post-treatment maximum intensity projection (MIP) b 800 grey-scale inverted DWI (d). Pre-treatment images show multiple hepatic (white arrow in (a,b) and black arrow in (c) and bone (white curved arrow in (a,b), black curved arrow in c) locations of disease with complete response after treatment (d).