Evaluation of [18F]-FDG-Based Hybrid Imaging Combinations for Assessment of Bone Marrow Involvement in Lymphoma at Initial Staging

• Published in: PloS one 2016-10, Vol.11 (10), p.e0164118-e0164118
• Main Authors: Asenbaum, Ulrika, Nolz, Richard, Karanikas, Georgios, Furtner, Julia, Woitek, Ramona, Staudenherz, Anton, Senn, Daniela, Raderer, Markus, Weber, Michael, Simonitsch-Klupp, Ingrid, Mayerhoefer, Marius E
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biology and Life Sciences; Biopsy; Bone imaging; Bone marrow; Bone Marrow - pathology; Computed tomography; Diagnostic systems; Drunk driving; False Negative Reactions; Female; Fluorodeoxyglucose F18 - chemistry; Humans; Image Processing, Computer-Assisted; Imaging; Infiltration; Lymphoma; Lymphoma - diagnosis; Lymphoma - diagnostic imaging; Lymphoma - pathology; Lymphomas; Magnetic Resonance Imaging; Male; Medical imaging; Medical prognosis; Medicine and Health Sciences; Metastasis; Middle Aged; Neoplasm Staging; NMR; Non-Hodgkin's lymphomas; Nuclear magnetic resonance; Nuclear medicine; Oncology; Patients; PET imaging; Positron emission; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals - chemistry; Research and Analysis Methods; Retrospective Studies; Sensitivity; Sensitivity analysis; Sensitivity and Specificity; Statistical analysis; Tomography; Tumors; Whole Body Imaging; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0164118

The purpose of our study was to determine the value of different hybrid imaging combinations for the detection of focal and diffuse bone marrow infiltration in lymphoma. Patients with histologically proven lymphoma, who underwent both [18F]-FDG-PET/CT and whole-body MRI (including T1- and diffusion-weighted [DWI] sequences) within seven days, and a subsequent bone marrow biopsy, were retrospectively included. Three hybrid imaging combinations were evaluated: (1) [18F]-FDG-PET/CT; (2) [18F]-FDG-PET/T1; and (3) [18F]-FDG-PET/DWI. The presence of focal or diffuse bone marrow infiltration was assessed by two rater teams. Sensitivity, specificity, and accuracy for the detection of overall, focal, and diffuse bone marrow involvement were compared between the three hybrid imaging combinations. Overall, lymphomatous bone marrow involvement was found in 16/60 patients (focal, 8; diffuse, 8). Overall sensitivity, specificity, and accuracy were 81.3%, 95.5%, and 91.7% for [18F]-FDG-PET/CT; 81.3%, 97.7%, and 93.3% for [18F]-FDG-PET/T1; and 81.3%, 95.5%, and 91.7% for [18F]-FDG-PET/DWI. No statistically significant differences between the three imaging combinations were observed, based on overall bone marrow involvement, focal involvement, or diffuse involvement. The sensitivity of all three imaging combinations for detecting diffuse bone marrow involvement was only moderate (62.5% for all three combinations). Although the combination of [18F]-FDG-PET and T1-weighted MRI generally showed the best diagnostic performance for the detection of bone marrow involvement in lymphoma, it was not significantly superior to the two other hybrid imaging combinations. Since the sensitivity of all imaging combinations for the detection of diffuse bone marrow involvement was only moderate, bone marrow biopsy cannot be replaced by imaging as yet.