Whole-body MRI with diffusion-weighted imaging: a valuable alternative to contrast-enhanced CT for initial staging of aggressive lymphoma

• Published in: Clinical radiology 2016-03, Vol.71 (3), p.271-279
• Main Authors: Balbo-Mussetto, A, Cirillo, S, Bruna, R, Gueli, A, Saviolo, C, Petracchini, M, Fornari, A, Lario, C.V, Gottardi, D, De Crescenzo, A, Tarella, C
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biopsy; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging - methods; Female; Fluorodeoxyglucose F18; Humans; Image Interpretation, Computer-Assisted; Iohexol - analogs & derivatives; Lymphoma - diagnosis; Lymphoma - diagnostic imaging; Lymphoma - pathology; Magnetic Resonance Imaging - methods; Male; Middle Aged; Multimodal Imaging; Neoplasm Staging; Positron-Emission Tomography; Radiology; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Whole Body Imaging - methods
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2015.11.018

Aim To compare the accuracy of whole-body magnetic resonance imaging (Wb-MRI) with diffusion-weighted imaging (DWI) to that of contrast-enhanced computed tomography (CE-CT) and 2-[18 F]-fluoro-2-deoxy- d- glucose (18 F-FDG) positron-emission tomography co-registered with low dose-CT (PET-CT) in defining lymphoma disease stage. Materials and methods From February 2010 to May 2014, 41 lymphoma patients underwent Wb-MRI-DWI, CE-CT, and18 F-FDG PET-CT. Histological subtypes included aggressive B-cell ( n =11), follicular ( n =13), mantle cell ( n =3), and Hodgkin's ( n =14) lymphoma. To compare the procedures, the reference standard (RS) assessment was defined by combining the results from18 F-FDG PET-CT, CE-CT, and bone marrow (BM) histology, modifications after therapy, and histological re-assessments of uncertain lesions. Results Among 1025 nodal sites, 217 had disease involvement according to the RS. CE-CT yielded 23 false-negative and 11 false-positive errors. Wb-MRI-DWI failed to recognise 17 localisations and had six false-positive errors;18 F-FDG PET-CT had no errors. Among 458 extranodal sites, 37 were positive according to the RS.18 F-FDG PET-CT yielded four false-negative and two false-positive results. CE-CT yielded 17 false-negative errors. Wb-MRI-DWI yielded a single false-negative error. Wb-MRI-DWI was the most reliable imaging technique for BM evaluation. Considering each procedure alone, the final stage would have been missed in four cases using18 F-FDG PET-CT, 12 cases using CE-CT, and none using Wb-MRI-DWI. Conclusion The present data support Wb-MRI-DWI as a sensitive and specific imaging technique for lymphoma evaluation, supporting its use in place of CE-CT for staging.