MRI and PET/MRI in hematologic malignancies

• Published in: Journal of magnetic resonance imaging 2020-05, Vol.51 (5), p.1325-1335
• Main Authors: Mayerhoefer, Marius E., Archibald, Stephen J., Messiou, Christina, Staudenherz, Anton, Berzaczy, Dominik, Schöder, Heiko
• Format: Article
• Language: English
• Subjects: Amino acids; Avidity; Blood cancer; Child; Clinical trials; Computed tomography; CXCR4 protein; Emission analysis; Fluorodeoxyglucose F18; Functional magnetic resonance imaging; Hematologic Neoplasms - diagnostic imaging; Hematology; Humans; Leukemia; Lymphoid tissue; Lymphoma; Magnetic Resonance Imaging; Medical imaging; Methionine; MRI; Mucosa; Mucosal-associated lymphoid tissue; Multiple myeloma; Myeloma; PET; Positron emission; Positron emission tomography; Positron Emission Tomography Computed Tomography; Radioactive tracers; Radiopharmaceuticals; Review; Sensitivity analysis; Therapeutic applications; Tomography; Whole Body Imaging
• ISSN: 1053-1807; 1522-2586
• DOI: 10.1002/jmri.26848

The role of MRI differs considerably between the three main groups of hematological malignancies: lymphoma, leukemia, and myeloma. In myeloma, whole‐body MRI (WB‐MRI) is recognized as a highly sensitive test for the assessment of myeloma, and is also endorsed by clinical guidelines, especially for detection and staging. In lymphoma, WB‐MRI is presently not recommended, and merely serves as an alternative technique to the current standard imaging test, [18F]FDG‐PET/CT, especially in pediatric patients. Even for lymphomas with variable FDG avidity, such as extranodal mucosa‐associated lymphoid tissue lymphoma (MALT), contrast‐enhanced computed tomography (CT), but not WB‐MRI, is presently recommended, despite the high sensitivity of diffusion‐weighted MRI and its ability to capture treatment response that has been reported in the literature. In leukemia, neither MRI nor any other cross‐sectional imaging test (including positron emission tomography [PET]) is currently recommended outside of clinical trials. This review article discusses current clinical applications as well as the main research topics for MRI, as well as PET/MRI, in the field of hematological malignancies, with a focus on functional MRI techniques such as diffusion‐weighted imaging and dynamic contrast‐enhanced MRI, on the one hand, and novel, non‐FDG PET imaging probes such as the CXCR4 radiotracer [68Ga]Ga‐Pentixafor and the amino acid radiotracer [11C]methionine, on the other hand. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1325–1335.