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Whole-body MRI for initial staging of paediatric lymphoma: prospective comparison to an FDG-PET/CT-based reference standard
Authors:Annemieke S Littooij  Thomas C Kwee  Ignasi Barber  Claudio Granata  Malou A Vermoolen  Goya Enríquez  József Zsíros  Shui Yen Soh  Bart de Keizer  Frederik J A Beek  Monique G Hobbelink  Marc B Bierings  Jaap Stoker  Rutger AJ Nievelstein
Institution:1. Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht/Wilhelmina Children’s Hospital, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
2. Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
3. Department of Paediatric Radiology, Hospital Materno-Infantil Vall d’Hebron, P. de la Vall d’Hebron, Barcelona, Spain
4. Department of Radiology, IRCCS Giannina Gaslini Hospital, Via Gerolamo Gaslini 5, 16148, Genoa, Italy
5. Department of Paediatric Oncology, Emma Children’s Hospital, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
6. Haematology and Oncology service, Department of Paediatric Subspecialities, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
7. Department of Paediatric Haematology-Oncology, University Medical Centre Utrecht/Wilhelmina Children’s Hospital, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
8. Department of Radiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
Abstract:

Objective

To compare whole-body MRI, including diffusion-weighted imaging (whole-body MRI-DWI), with FDG-PET/CT for staging newly diagnosed paediatric lymphoma.

Methods

A total of 36 children with newly diagnosed lymphoma prospectively underwent both whole-body MRI-DWI and FDG-PET/CT. Whole-body MRI-DWI was successfully performed in 33 patients (mean age 13.9 years). Whole-body MRI-DWI was independently evaluated by two blinded observers. After consensus reading, an unblinded expert panel evaluated the discrepant findings between whole-body MRI-DWI and FDG-PET/CT and used bone marrow biopsy, other imaging data and clinical information to derive an FDG-PET/CT-based reference standard.

Results

Interobserver agreement of whole-body MRI-DWI was good all nodal sites together (κ = 0.79); all extranodal sites together (κ = 0.69)]. There was very good agreement between the consensus whole-body MRI-DWI- and FDG-PET/CT-based reference standard for nodal (κ = 0.91) and extranodal (κ = 0.94) staging. The sensitivity and specificity of consensus whole-body MRI-DWI were 93 % and 98 % for nodal staging and 89 % and 100 % for extranodal staging, respectively. Following removal of MRI reader errors, the disease stage according to whole-body MRI-DWI agreed with the reference standard in 28 of 33 patients.

Conclusions

Our results indicate that whole-body MRI-DWI is feasible for staging paediatric lymphoma and could potentially serve as a good radiation-free alternative to FDG-PET/CT.

Keypoints

? Accurate staging is important for treatment planning and assessing prognosis ? Whole-body MRI-DWI could be a good radiation-free alternative to FDG-PET/CT ? Interobserver agreement of whole-body MRI-DWI is good ? Agreement between whole-body MRI and the FDG-PET/CT reference standard is good ? Most discrepancies were caused by suboptimal accuracy of size measurements on MRI
Keywords:
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