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Kohan A, Hanneman K, Mirshahvalad SA, Afaq A, Mallak N, Metser U, Veit-Haibach P. Current Applications of PET/MR: Part II: Clinical Applications II. Can Assoc Radiol J 2024:8465371241255904. [PMID: 38836428 DOI: 10.1177/08465371241255904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
Due to the major improvements in the hardware and image reconstruction algorithms, positron emission tomography/magnetic resonance imaging (PET/MR) is now a reliable state-of-the-art hybrid modality in medical practice. Currently, it can provide a broad range of advantages in preclinical and clinical imaging compared to single-modality imaging. In the second part of this review, we discussed the further clinical applications of PET/MR. In the chest, PET/MR has particular potential in the oncology setting, especially when utilizing ultrashort/zero echo time MR sequences. Furthermore, cardiac PET/MR can provide reliable information in evaluating myocardial inflammation, cardiac amyloidosis, myocardial perfusion, myocardial viability, atherosclerotic plaque, and cardiac masses. In gastrointestinal and hepato-pancreato-biliary malignancies, PET/MR is able to precisely detect metastases to the liver, being superior over the other imaging modalities. In genitourinary and gynaecology applications, PET/MR is a comprehensive diagnostic method, especially in prostate, endometrial, and cervical cancers. Its simultaneous acquisition has been shown to outperform other imaging techniques for the detection of pelvic nodal metastases and is also a reliable modality in radiation planning. Lastly, in haematologic malignancies, PET/MR can significantly enhance lymphoma diagnosis, particularly in detecting extra-nodal involvement. It can also comprehensively assess treatment-induced changes. Furthermore, PET/MR may soon become a routine in multiple myeloma management, being a one-stop shop for evaluating bone, bone marrow, and soft tissues.
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Affiliation(s)
- Andres Kohan
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Kate Hanneman
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Seyed Ali Mirshahvalad
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Asim Afaq
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nadine Mallak
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Ur Metser
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Patrick Veit-Haibach
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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Morakote W, Baratto L, Ramasamy SK, Adams LC, Liang T, Sarrami AH, Daldrup-Link HE. Comparison of diffusion-weighted MRI and [ 18F]FDG PET/MRI for treatment monitoring in pediatric Hodgkin and non-Hodgkin lymphoma. Eur Radiol 2024; 34:643-653. [PMID: 37542653 PMCID: PMC10993778 DOI: 10.1007/s00330-023-10015-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/16/2023] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE To compare tumor therapy response assessments with whole-body diffusion-weighted imaging (WB-DWI) and 18F-fluorodeoxyglucose ([18F]FDG) PET/MRI in pediatric patients with Hodgkin lymphoma and non-Hodgkin lymphoma. MATERIALS AND METHODS In a retrospective, non-randomized single-center study, we reviewed serial simultaneous WB-DWI and [18F]FDG PET/MRI scans of 45 children and young adults (27 males; mean age, 13 years ± 5 [standard deviation]; age range, 1-21 years) with Hodgkin lymphoma (n = 20) and non-Hodgkin lymphoma (n = 25) between February 2018 and October 2022. We measured minimum tumor apparent diffusion coefficient (ADCmin) and maximum standardized uptake value (SUVmax) of up to six target lesions and assessed therapy response according to Lugano criteria and modified criteria for WB-DWI. We evaluated the agreement between WB-DWI- and [18F]FDG PET/MRI-based response classifications with Gwet's agreement coefficient (AC). RESULTS After induction chemotherapy, 95% (19 of 20) of patients with Hodgkin lymphoma and 72% (18 of 25) of patients with non-Hodgkin lymphoma showed concordant response in tumor metabolism and proton diffusion. We found a high agreement between treatment response assessments on WB-DWI and [18F]FDG PET/MRI (Gwet's AC = 0.94; 95% confidence interval [CI]: 0.82, 1.00) in patients with Hodgkin lymphoma, and a lower agreement for patients with non-Hodgkin lymphoma (Gwet's AC = 0.66; 95% CI: 0.43, 0.90). After completion of therapy, there was an excellent agreement between WB-DWI and [18F]FDG PET/MRI response assessments (Gwet's AC = 0.97; 95% CI: 0.91, 1). CONCLUSION Therapy response of Hodgkin lymphoma can be evaluated with either [18F]FDG PET or WB-DWI, whereas patients with non-Hodgkin lymphoma may benefit from a combined approach. CLINICAL RELEVANCE STATEMENT Hodgkin lymphoma and non-Hodgkin lymphoma exhibit different patterns of tumor response to induction chemotherapy on diffusion-weighted MRI and PET/MRI. KEY POINTS • Diffusion-weighted imaging has been proposed as an alternative imaging to assess tumor response without ionizing radiation. • After induction therapy, whole-body diffusion-weighted imaging and PET/MRI revealed a higher agreement in patients with Hodgkin lymphoma than in those with non-Hodgkin lymphoma. • At the end of therapy, whole-body diffusion-weighted imaging and PET/MRI revealed an excellent agreement for overall tumor therapy responses for all lymphoma types.
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Affiliation(s)
- Wipawee Morakote
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Palo Alto, CA, 94304, USA
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Lucia Baratto
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Palo Alto, CA, 94304, USA
| | - Shakthi K Ramasamy
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Palo Alto, CA, 94304, USA
| | - Lisa C Adams
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Palo Alto, CA, 94304, USA
| | - Tie Liang
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Palo Alto, CA, 94304, USA
| | - Amir H Sarrami
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Palo Alto, CA, 94304, USA
| | - Heike E Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Palo Alto, CA, 94304, USA.
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Lambert L, Burgetova A, Trneny M, Bircakova B, Molinsky J, Benesova K, Zogala D, Michalek P. The diagnostic performance of whole-body MRI in the staging of lymphomas in adult patients compared to PET/CT and enhanced reference standard-systematic review and meta-analysis. Quant Imaging Med Surg 2022; 12:1558-1570. [PMID: 35111648 DOI: 10.21037/qims-21-649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/26/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Morphology highlighted by diffusion weighted imaging (DWI) is the basis of whole-body MRI (wbMRI). The aim of this study was to analyze current knowledge on the diagnostic performance of wbMRI in the pretreatment staging of patients with lymphoma. METHODS A search for original articles reporting the diagnostic performance (sensitivity, specificity) of pretreatment (first staging or staging in relapsed patients after complete remission) wbMRI in nodal and extranodal involvement by extracranial lymphoma and the agreement of stage by the Cotswolds-modified Ann Arbor classification in adult patients compared to the reference standard (PET/CT or enhanced reference standard) was conducted in PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov. RESULTS Altogether 15 studies with 519 patients were included in the meta-analysis. The pooled sensitivity and specificity for nodal involvement were 0.93 (95% CI: 0.90 to 0.96) and 0.99 (95% CI: 0.98 to 1.00). For nodal staging, most studies used the size criterion of 10 mm in the short diameter (n=10) and the absence of prominent fatty hilum (n=4). Restricted diffusion on diffusion-weighted imaging as a sign of nodal involvement was either not used (n=5), used for detection (n=4), semi-quantitatively (n=4), or quantitatively (n=1). Only one study (7) relied solely on restricted diffusion as the main criterion for nodal involvement. The pooled sensitivity and specificity for extranodal involvement were 0.89 (95% CI: 0.79 to 0.98) and 0.99 (95% CI: 0.99 to 1.00). Seven studies considered diffuse splenic involvement when its long or vertical axis was greater than 13 cm regardless of the patient's physiognomy. The pooled agreement in staging (Cohen's kappa) was almost perfect (0.90, 95% CI: 0.84 to 0.95). DISCUSSION The sensitivity and specificity of wbMRI in the assessment of the nodal and extranodal involvement by lymphoma is high. The agreement of wbMRI with the reference standard is almost perfect.
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Affiliation(s)
- Lukas Lambert
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Andrea Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Marek Trneny
- Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Bianka Bircakova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Molinsky
- Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Katerina Benesova
- Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - David Zogala
- Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavel Michalek
- Department of Anaesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Whole-Body Magnetic Resonance Imaging: Current Role in Patients with Lymphoma. Diagnostics (Basel) 2021; 11:diagnostics11061007. [PMID: 34073062 PMCID: PMC8227037 DOI: 10.3390/diagnostics11061007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/13/2022] Open
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.
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5
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Multimodality imaging and treatment strategy for malignant scalp neoplasms in adults. Clin Imaging 2021; 77:48-57. [PMID: 33640791 DOI: 10.1016/j.clinimag.2021.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 12/30/2020] [Accepted: 02/21/2021] [Indexed: 11/22/2022]
Abstract
Malignant scalp masses deserve much attention as they have the potential to destroy local structures, recur and metastasize to distant organs. Moreover, malignant scalp lesions are known to be more aggressive in behavior than their counterparts elsewhere in the body. Multimodality imaging is essential in narrowing the differential diagnoses of scalp masses, as well as in differentiating benign from malignant masses. Furthermore, imaging is important in (1) evaluating the extent of tumor invasion in the scalp, (2) staging the disease, (3) guiding surgical biopsy and/or resection of the tumor, (4) preoperative planning and post-treatment surveillance of scalp tumors. An interdisciplinary treatment approach is crucial for the management of scalp malignancies given their complex and aggressive nature. This review seeks to describe the unique clinical and imaging characteristics of various types of malignant scalp masses, as well as to review their current treatment strategies.
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Usuda K, Iwai S, Yamagata A, Iijima Y, Motono N, Matoba M, Doai M, Yamada S, Ueda Y, Hirata K, Uramoto H. Diffusion-weighted whole-body imaging with background suppression (DWIBS) is effective and economical for detection of metastasis or recurrence of lung cancer. Thorac Cancer 2021; 12:676-684. [PMID: 33476488 PMCID: PMC7919163 DOI: 10.1111/1759-7714.13820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Diffusion-weighted whole-body imaging with background suppression (DWIBS) is used for the diagnosis and staging of cancers. The medical cost of an MR examination including DWIBS is $123, which is 80% less expensive than the cost ($798) of F18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) examination. METHODS This study examined the efficacy of DWIBS for relapses after lung cancer resection. A total of 55 patients who had pulmonary resection of lung cancer, postoperative computed tomography (CT) every six months, and DWIBS and FDG-PET/CT (every year) were enrolled in this study. If a metastatic lesion was detected on CT scan, DWIBS and FDG-PET/CT were also used. RESULTS A total of 55 patients who underwent pulmonary resections for lung cancer, and had CT, DWIBS and FDG-PET/CT examination during follow-up after pulmonary resection were enrolled in this study. Lung cancer in 32 patients relapsed. Postoperative radiographic examinations revealed pulmonary metastases in 17 patients, bone metastases in seven, liver metastases in five, lymph node metastases in five, pleural metastases in four, metastases to the chest wall in two, brain metastases in two, adrenal gland metastasis in one, and renal metastasis in one. The mean apparent diffusion coefficient (ADC) value of the relapse was 0.9 to 1.70 × 10-3 mm2 /s. The accuracy 0.98 (54/55) of DWIBS for detecting multiple metastatic lesions was likely to be higher than 0.94 (52/55) of CT or 0.94 (52/55) of FDG-PET/CT, but there were no significant differences. CONCLUSIONS DWIBS can detect multiple metastatic lesions throughout the entire body and differentiate malignancy from benignity in only one examination. DWIBS has benefits of diagnostic accuracy and is less expensive in medical costs for the detection of a relapse. DWIBS could potentially replace FDG-PET/CT after lung cancer resection.
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Affiliation(s)
- Katsuo Usuda
- Department of Thoracic Surgery, Kanazawa Medical University, Kahoku-gun, Japan
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, Kahoku-gun, Japan
| | - Aika Yamagata
- Department of Thoracic Surgery, Kanazawa Medical University, Kahoku-gun, Japan
| | - Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, Kahoku-gun, Japan
| | - Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, Kahoku-gun, Japan
| | - Munetaka Matoba
- Department of Radiology, Kanazawa Medical University, Kahoku-gun, Japan
| | - Mariko Doai
- Department of Radiology, Kanazawa Medical University, Kahoku-gun, Japan
| | - Sohsuke Yamada
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Yoshimichi Ueda
- Department of Pathophysiological and Experimental Pathology, Kanazawa Medical University, Kahoku-gun, Japan
| | - Keiya Hirata
- MRI Center, Kanazawa Medical University, Kahoku-gun, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, Kahoku-gun, Japan
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Hong GS, Chae EJ, Ryu JS, Chae SY, Lee HS, Yoon DH, Suh C. Assessment of naive indolent lymphoma using whole-body diffusion-weighted imaging and T2-weighted MRI: results of a prospective study in 30 patients. Cancer Imaging 2021; 21:5. [PMID: 33413685 PMCID: PMC7791993 DOI: 10.1186/s40644-020-00371-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/11/2020] [Indexed: 01/05/2023] Open
Abstract
Background We prospectively evaluated the diagnostic utility of whole-body diffusion-weighted imaging with background body signal suppression and T2-weighted short-tau inversion recovery MRI (WB-DWIBS/STIR) for the pretherapeutic staging of indolent lymphoma in 30 patients. Methods This prospective study included 30 treatment-naive patients with indolent lymphomas who underwent WB-DWIBS/STIR and conventional imaging workup plus biopsy. The pretherapeutic staging agreement, sensitivity, and specificity of WB-DWIBS/STIR were investigated with reference to the multimodality and multidisciplinary consensus review for nodal and extranodal lesions excluding bone marrow. Results In the pretherapeutic staging, WB-DWIBS/STIR showed very good agreement (κ = 0.96; confidence interval [CI], 0.88–1.00), high sensitivity (93.4–95.1%), and high specificity (99.0–99.4%) for the whole-body regions. These results were similar to those of 18F-FDG-PET/CT, except for the sensitivity for extranodal lesions. For extranodal lesions, WB-DWIBS/STIR showed higher sensitivity compared to 18F-FDG-PET/CT for the whole-body regions (94.9–96.8% vs. 79.6–86.3%, P = 0.058). Conclusion WB-DWIBS/STIR is an effective modality for the pretherapeutic staging of indolent lymphoma, and it has benefits when evaluating extranodal lesions, compared with 18F-FDG-PET/CT.
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Affiliation(s)
- Gil-Sun Hong
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
| | - Eun Jin Chae
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea.
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
| | - Sun Young Chae
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
| | - Hyo Sang Lee
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, 38, Bangdong-gil, Sacheon-myeon, Gangneung, South Korea
| | - Dok Hyun Yoon
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
| | - Cheolwon Suh
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
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Spijkers S, Littooij AS, Kwee TC, Tolboom N, Beishuizen A, Bruin MCA, Elias SG, van de Brug T, Enríquez G, Sábado C, Miller E, Granata C, de Lange C, Verzegnassi F, Greer MLC, de Keizer B, Nievelstein RAJ. Whole-body MRI versus an FDG-PET/CT-based reference standard for staging of paediatric Hodgkin lymphoma: a prospective multicentre study. Eur Radiol 2020; 31:1494-1504. [PMID: 32880696 PMCID: PMC7880958 DOI: 10.1007/s00330-020-07182-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/02/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022]
Abstract
Objectives To assess the concordance of whole-body MRI (WB-MRI) and an FDG-PET/CT-based reference standard for the initial staging in children with Hodgkin lymphoma (HL) Methods Children with newly diagnosed HL were included in this prospective, multicentre, international study and underwent WB-MRI and FDG-PET/CT at staging. Two radiologists and a nuclear medicine physician independently evaluated all images. Discrepancies between WB-MRI and FDG-PET/CT were assessed by an expert panel. All FDG-PET/CT errors were corrected to derive the FDG-PET/CT-based reference standard. The expert panel corrected all reader errors in the WB-MRI DWI dataset to form the intrinsic MRI data. Inter-observer agreement for WB-MRI DWI was calculated using overall agreement, specific agreements and kappa statistics. Concordance for correct classification of all disease sites and disease stage between WB-MRI (without DWI, with DWI and intrinsic WB-MRI DWI) and the reference standard was calculated as primary outcome. Secondary outcomes included positive predictive value, negative predictive value and kappa statistics. Clustering within patients was accounted for using a mixed-effect logistic regression model with random intercepts and a multilevel kappa analysis. Results Sixty-eight children were included. Inter-observer agreement between WB-MRI DWI readers was good for disease stage (κ = 0.74). WB-MRI DWI agreed with the FDG-PET/CT-based reference standard for determining disease stage in 96% of the patients versus 88% for WB-MRI without DWI. Agreement between WB-MRI DWI and the reference standard was excellent for both nodal (98%) and extra-nodal (100%) staging. Conclusions WB-MRI DWI showed excellent agreement with the FDG-PET/CT-based reference standard. The addition of DWI to the WB-MRI protocol improved the staging agreement. Key Points • This study showed excellent agreement between WB-MRI DWI and an FDG-PET/CT-based reference standard for staging paediatric HL. • Diffusion-weighted imaging is a useful addition to WB-MRI in staging paediatric HL. • Inter-observer agreement for WB-MRI DWI was good for both nodal and extra-nodal staging and determining disease stage. Electronic supplementary material The online version of this article (10.1007/s00330-020-07182-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Suzanne Spijkers
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Annemieke S Littooij
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, Department of Radiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Nelleke Tolboom
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - Auke Beishuizen
- Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands.,Department of Paediatric Oncology/Haematology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marrie C A Bruin
- Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tim van de Brug
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | | | - Constantino Sábado
- Department of Paediatric Oncology and Haematology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Elka Miller
- Department of Medical Imaging, CHEO, University of Ottawa, Ottawa, Canada
| | - Claudio Granata
- Department of Paediatric Radiology, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Charlotte de Lange
- Department of Diagnostic Imaging and Intervention, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Federico Verzegnassi
- Oncohematology Unit, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - Rutger A J Nievelstein
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
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Nesterova ES, Yatsyk GA, Lutsik NS, Kravchenko SK, Sudarikov AB, Krasil'nikova IV, Gemdzhian EG, Kovrigina AM. [Informativeness of whole-body diffusion-weighted magnetic resonance imaging and positron emission tomography with computed tomography in follicular lymphoma]. TERAPEVT ARKH 2020; 92:55-62. [PMID: 33346445 DOI: 10.26442/00403660.2020.07.000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Indexed: 11/22/2022]
Abstract
AIM This study conducted the possibilities of diffusion-weighted magnetic resonance imaging of the whole body diffusion WB-MRI (in comparison with positron emission tomography with computed tomography PET/CT) in assessing the volume and prevalence of the tumor, as well as determining bone marrow (BM) damage (for various cytological types) in the diagnosis and staging of the disease in patients with FL. MATERIALS AND METHODS A prospective comparative search study included 15 patients (4 men and 11 women, with a median age of 53 years) with newly diagnosed FL. Patients have not received antitumor chemotherapy previously. After the diagnosis was established, all patients (with the blindness of both the cases themselves and some specialists regarding the results of other specialists) were examined by PET/CT and diffusion WB-MRI, after which a BM examination was performed (histological examination and determination of B-cell clonality in BM puncture by PCR). Using the diffusion WB-MRI method, the prevalence of tumor lesion (nodal and extranodal foci) in each patient was estimated, and the total tumor volume was calculated, BM lesion was detected, and BM lesion volume was calculated. For lesions of different localization, the measured diffusion coefficient (DC) of the diffusion WB-MRI and the standardized rate of accumulation of the radiopharmaceutical in tissues (SUV) of the PET/CT method were determined and compared with each other (for the same areas). Statistical analysis was performed using the estimate of agreement (by Cohens kappa coefficient and asymptotic test) of the results of the compared methods. RESULTS Estimates of the prevalence of tumor damage (lymph nodes and extranodal foci) using the diffusion WB-MRI and PET/CT methods were the same. High DC and SUV were observed in the peripheral lymph nodes, extranodal foci and bulky, low DC and SUV in the foci of BM. All 4 methods successfully determined BM damage, however, the diffusion WB-MRI had comparatively less negative results. The highest values of SUV and CD were noted in cases of the 3 grade of FL. Using the diffusion WB-MRI method, the prevalence of tumor lesion was assessed in each patient (nodal and extranodal foci were detected) and the total tumor volume was calculated, BM lesion detection was performed, and the volume of BM lesion was calculated. It is important to note that with the help of diffusion WB-MRI, it was possible to measure separately the total tumor volume (462025 cm3) and separately the volume of bulky (251358 cm3). The diffusion WB-MRI allowed us to differentiate the volume of tumor tissue (reduced as a result of treatment) and residual (fibrous-adipose) tissue in residual formations (which averaged 21% of the initial volume). The predictors of a poor antitumor response were the maximum SUV values (more than 14.0) and the minimum DC values (0.510-3mm2/s) in the BM foci. CONCLUSION The diffusion WB-MRI allows for detailed visualization of BM lesions and surrounding soft tissues both in the debut of the FL and in the process of tracking the effectiveness of chemotherapy, which makes it possible to use it along with PET/CT. Diffusion WB-MRI allows to separately evaluate the volume of true tumor tissue and residual tissue. Cases of the 3 grade of FL (including the transformation of FL into diffuse B-large cell lymphoma) are isolated due to low DC values (and high SUV values) in the tumor tissue. BM foci of FL lesion also have (in comparison with nodal and extranodal foci) lower DC values. The predictors of a poor antitumor response were high (from 14.0 or more) SUV valuesin the tumor (and especially in bulky), and low (about 0.5103mm2/s) DC values of BM foci. The PET/CT and diffusion WB-MRI have proven to be reliable diagnostic tools for establishing the stage of FL and detecting BM damage. Diffusion WB-MRI for FL is an informative first-line diagnostic method that allows regular monitoring of the disease and early detection of foci of relapse and disease progression.
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Abstract
Hybrid imaging using the tracer [18F]FDG (2‑deoxy-2-fluoro-D-glucose) is regarded as the backbone of the diagnostic workup of lymphomas. All international guidelines, and especially the Lugano and RECIL (Response Evaluation Criteria in Lymphoma) guidelines, currently recommend [18F]FDG-PET/CT (positron emission tomography/computed tomography) for staging and treatment response assessment. With the exception of pediatric lymphomas, neither PET/MRI (magnetic resonance imaging) nor whole-body MRI are currently endorsed by international guidelines, despite the fact that both techniques have clear advantages over [18F]FDG-PET/CT in the assessment of lymphomas with variable FDG avidity. Of the new, more specific PET tracers that are being evaluated for the use in lymphomas, the CXCR4 (CXC motif chemokine receptor 4) tracer [68Ga]Pentixafor is of particular interest, as initial studies have shown that it may be used to visualize frequently non-FDG-avid lymphomas such as small-cell lymphocytic lymphoma, mucosa-associated lymphoid tissue (MALT) lymphoma and lymphomplasmacytic lymphoma.
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Affiliation(s)
- Marius E Mayerhöfer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, 10065, New York, USA.
- Univ.-Klinik für Radiologie und Nuklearmedizin, Abteilung für Allgemeine und Kinderradiologie, Medizinische Universität Wien, Währinger Gürtel 18-20, Wien, 1090, Österreich.
| | - Alexander Haug
- Univ.-Klinik für Radiologie und Nuklearmedizin, Abteilung für Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, Wien, 1090, Österreich
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11
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Comparison of whole-body MRI with diffusion-weighted imaging and PET/CT in lymphoma staging. Eur Radiol 2020; 30:3915-3923. [PMID: 32103366 DOI: 10.1007/s00330-020-06732-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/30/2020] [Accepted: 02/07/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To compare the diagnostic efficiency of whole-body MRI-DWI and PET/CT in lymphoma staging. METHODS A prospective study enrolled 92 patients with lymphoma. Prior to treatment, all patients underwent whole-body MRI-DWI and PET-CT. The methods' efficiency was compared in the diagnosis of lymph node (LN) and organ involvement, and in determining lymphoma stage. RESULTS Sensitivity, specificity, and accuracy in the diagnosis of enlarged LN involvement were 98.2%, 99.9%, and 99.3%, respectively, for MRI-DWI, and 99.4%, 100.0%, and 99.8%, respectively, for PET/CT. ROC analysis showed similar methods' efficiency in the diagnosis of enlarged LN involvement (p > 0.06). MRI-DWI and PET/CT sensitivity in the diagnosis of non-enlarged LN involvement was 77.8% and 88.1%, respectively (p < 0.001). MRI-DWI and PET/CT sensitivity, specificity, and accuracy in the diagnosis of lung involvement were 73.3%, 98.7%, 94.6% and 86.7%, 98.7%, 96.7%; spleen involvement 54.8%, 98.3%, 83.3% and 100.0%, 100.0%, 100.0%; bone marrow involvement 87.1%, 96.4%, 93.0% and 64.5%, 87.3%, 79.1%; and all-organ involvement 72.9%, 98.1%, 91.4% and 80.0%, 96.6%, 92.2%, respectively. ROC analysis showed similar methods' efficiency in the diagnosis of lung involvement (р > 0.3), higher for PET/CT in spleen involvement (р < 0.0001), higher for MRI-DWI in bone marrow involvement (р < 0.0008), and similar in all-organ involvement (р > 0.35). MRI-DWI and PET/CT determined the correct lymphoma stage in 79 (86%) patients. CONCLUSIONS Whole-body MRI-DWI and PET/CT determined the correct lymphoma stage in similar numbers of patients. MRI-DWI can serve as a non-irradiative alternative to PET/CT in lymphoma staging. KEY POINTS • Whole-body MRI-DWI efficiency compared with that of PET/CT is similar in the diagnosis of enlarged LN involvement, inferior in the diagnosis of non-enlarged LN and spleen involvement, but superior in the diagnosis of bone marrow involvement. • A new efficient MRI-DWI sign for diagnosis of diffuse bone marrow involvement has been proposed, i.e., a diffuse increase in spine signal intensity on high b value DWI images above the kidney parenchyma. • MRI-DWI and PET/CT determined the correct lymphoma stage in similar numbers of patients.
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12
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Albano D, Bruno A, Patti C, Micci G, Midiri M, Tarella C, Galia M. Whole‐body magnetic resonance imaging (WB‐MRI) in lymphoma: State of the art. Hematol Oncol 2019; 38:12-21. [DOI: 10.1002/hon.2676] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/31/2019] [Accepted: 09/03/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Domenico Albano
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences and Advanced DiagnosticsUniversity of Palermo Palermo Italy
- IRCCS Istituto Ortopedico Galeazzi, Unit of Diagnostic and Interventional Radiology Milan Italy
| | - Alberto Bruno
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences and Advanced DiagnosticsUniversity of Palermo Palermo Italy
| | - Caterina Patti
- Department of Hematology IAzienda Ospedaliera Ospedali Riuniti Villa Sofia‐Cervello Palermo Italy
| | - Giuseppe Micci
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences and Advanced DiagnosticsUniversity of Palermo Palermo Italy
| | - Massimo Midiri
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences and Advanced DiagnosticsUniversity of Palermo Palermo Italy
| | - Corrado Tarella
- Hemato‐Oncology DivisionIEO, European Institute of Oncology IRCCS Milan Italy
- Dip. Sc. SaluteUniversity of Milan Milan Italy
| | - Massimo Galia
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences and Advanced DiagnosticsUniversity of Palermo Palermo Italy
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Gavrilina OA, Troitskaya VV, Baskhaeva GA, Lukyanova IA, Zarubina KI, Parovichnikova EN. APPLICATION OF POSITRON EMISSION TOMOGRAPHY / COMPUTER TOMOGRAPHY FOR EVALUATING THE RESPONSE TO CHEMOTHERAPY IN PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA / LYMPHOBLASTIC LYMPHOMA. RUSSIAN JOURNAL OF HEMATOLOGY AND TRANSFUSIOLOGY 2019. [DOI: 10.35754/0234-5730-2019-64-2-138-149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction.No recommendations are currently available on the use of positron emission tomography / computer tomography (PET/CT) for evaluating the response to chemotherapy in patients with acute lymphoblastic leukosis / lymphoblastic lymphoma (ALL/LBL).Aim. The aim of this research was to study the ability of tumour cells to accumulate radiopharmaceuticals during PET/CT in patients with ALL/LBL, as well as to evaluate the prognostic value of PET/CT results performed after completion of consolidation therapy with/without autologous hematopoietic blood stem cell transplantation (auto-HSCT) in patients with Ph-negative ALL/LLL who underwent therapy according to the protocols of a Russian research group ALL-2009/ALL-2016.Materials and methods.PET/CT was performed in 3 patients with various variants of a newly diagnosed ALL before the onset of therapy and after the completion of induction therapy. In 10 patients with Ph-negative ALL/LLL, a PET study was performed after consolidation had been completed according to the ALL-2009/ALL-2016 protocol.Results. The results of PET/CT in 3 patients with different variants of newly detected ALL/LBL were analysed. All patients showed a metabolic activity of 18F-FDG in all morphologically and immunohistochemically (immunophenotypically) confirmed lesions. An analysis of the PET/CT results in 10 patients with Ph-negative ALL/LBL after completion of consolidation therapy with/without auto-HSCT showed that all patients had achieved a PET-negative disease remission. With a median follow-up of 20.5 months (from 15 to 44 months), only one out of 10 patients demonstrated isolated neurorecurrence 10 months after achieving remission. The remaining 9 patients, under a median relapse-free survival rate of 19 months (from 14 to 43 months), demonstrated complete clinical and hematological remission.Conclusion. Specific medullary and extramedullary lesions in ALL/LBL are capable of accumulating 18F-FDG in PET, which allows the method under study to be used for evaluating the completeness of remission in extramedullary lesions. The prognostic feasibility of PET/CT under the involvement of the central nervous system remains to be studied.
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14
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Alves AMA, Torres US, Velloni FG, Ribeiro BJ, Tiferes DA, D'Ippolito G. The many faces of primary and secondary hepatic lymphoma: imaging manifestations and diagnostic approach. Radiol Bras 2019; 52:325-330. [PMID: 31656351 PMCID: PMC6808615 DOI: 10.1590/0100-3984.2018.0013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hepatic lymphoma can be divided into its primary and secondary forms. To be classified as primary hepatic lymphoma, the disease should be limited to the liver and hilar lymph nodes, with no distant involvement (to the bone marrow or other sites). Primary hepatic lymphoma is quite rare, accounting for less than 1% of all cases of non-Hodgkin lymphoma, whereas secondary hepatic lymphoma affects nearly half of such cases. Familiarity with the imaging features of hepatic lymphoma is important for its early diagnosis and appropriate management. In this essay, we aim to review the roles of computed tomography and magnetic resonance imaging in identifying and monitoring hepatic lymphomas, using sample cases to describe and illustrate the wide spectrum of imaging findings in the primary and secondary forms of this disorder.
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Affiliation(s)
- Aldo Maurici Araújo Alves
- Department of Diagnostic Imaging, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | - Fernanda Garozzo Velloni
- Department of Diagnostic Imaging, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Diagnósticos da América S/A, Barueri, SP, Brazil
| | - Bruno Jucá Ribeiro
- Department of Diagnostic Imaging, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Dario Ariel Tiferes
- Department of Diagnostic Imaging, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Grupo Fleury, São Paulo, SP, Brazil
| | - Giuseppe D'Ippolito
- Department of Diagnostic Imaging, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Grupo Fleury, São Paulo, SP, Brazil
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15
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Mayerhoefer ME, Archibald SJ, Messiou C, Staudenherz A, Berzaczy D, Schöder H. MRI and PET/MRI in hematologic malignancies. J Magn Reson Imaging 2019; 51:1325-1335. [PMID: 31260155 PMCID: PMC7217155 DOI: 10.1002/jmri.26848] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/17/2019] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Marius E Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Austria.,Department of Radiology, Memorial Sloan Kettering Cancer Center New York, New York, USA
| | | | - Christina Messiou
- Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | - Anton Staudenherz
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - Dominik Berzaczy
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Austria
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center New York, New York, USA
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16
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Baranska D, Matera K, Podgorski M, Gorska-Chrzastek M, Krajewska K, Trelinska J, Grzelak P. Feasibility of diffusion-weighted imaging with DWIBS in staging Hodgkin lymphoma in pediatric patients: comparison with PET/CT. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2018; 32:381-390. [PMID: 30498885 PMCID: PMC6525117 DOI: 10.1007/s10334-018-0726-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 12/17/2022]
Abstract
Objective The aim of the study was to evaluate feasibility of diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) method in diagnosing Hodgkin lymphoma in pediatric patients and to compare it with 18F-FDG PET/CT as a gold standard. Materials and methods Eleven patients (median age 14) with newly diagnosed Hodgkin lymphoma were examined with 18F-FDG PET/CT and MRI including whole-body DWIBS sequence (b = 0, 800 s/mm2), before the oncologic treatment. About 26 locations of lymphatic tissues were evaluated visually and quantitatively using ADCmean (DWIBS) and SUVmax (18F-FDG PET/CT), respectively. Results All affected lymph node regions (n = 134) diagnosed in 18F-FDG PET/CT were found with DWIBS, presenting decreased diffusion. Significant correlation was found between ADC and SUV values (R2 = − 0.37; p = 0.0001). Nevertheless, additional 33 regions were recognized only by DWIBS. They were significantly smaller than regions diagnosed by both methods. Discussion Agreement between DWIBS and 18F-FDG PET/CT for detection and staging of malignant lymphoma is high. DWIBS can be used for the evaluation of pediatric Hodgkin lymphoma.
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Affiliation(s)
- Dobromila Baranska
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital-Research Institute in Lodz, Rzgowska 281/289, 93-338, Lodz, Poland
| | - Katarzyna Matera
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital-Research Institute in Lodz, Rzgowska 281/289, 93-338, Lodz, Poland.
| | - Michal Podgorski
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital-Research Institute in Lodz, Rzgowska 281/289, 93-338, Lodz, Poland
| | | | - Karolina Krajewska
- Department of Pediatrics, Oncology, Hematology and Diabetology Medical, University of Lodz, Pankiewicza 16, 91-738, Lodz, Poland
| | - Joanna Trelinska
- Department of Pediatrics, Oncology, Hematology and Diabetology Medical, University of Lodz, Pankiewicza 16, 91-738, Lodz, Poland
| | - Piotr Grzelak
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital-Research Institute in Lodz, Rzgowska 281/289, 93-338, Lodz, Poland
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17
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Petralia G, Padhani AR, Pricolo P, Zugni F, Martinetti M, Summers PE, Grazioli L, Colagrande S, Giovagnoni A, Bellomi M. Whole-body magnetic resonance imaging (WB-MRI) in oncology: recommendations and key uses. Radiol Med 2018; 124:218-233. [PMID: 30430385 DOI: 10.1007/s11547-018-0955-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/23/2018] [Indexed: 12/16/2022]
Abstract
The past decade has witnessed a growing role and increasing use of whole-body magnetic resonance imaging (WB-MRI). Driving these successes are developments in both hardware and software that have reduced overall examination times and significantly improved MR imaging quality. In addition, radiologists and clinicians have continued to find promising new applications of this innovative imaging technique that brings together morphologic and functional characterization of tissues. In oncology, the role of WB-MRI has expanded to the point of being recommended in international guidelines for the assessment of several cancer histotypes (multiple myeloma, melanoma, prostate cancer) and cancer-prone syndromes (Li-Fraumeni and hereditary paraganglioma-pheochromocytoma syndromes). The literature shows growing use of WB-MRI for the staging and follow-up of other cancer histotypes and cancer-related syndromes (including breast cancer, lymphoma, neurofibromatosis, and von Hippel-Lindau syndromes). The main aim of this review is to examine the current scientific evidence for the use of WB-MRI in oncology.
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Affiliation(s)
- Giuseppe Petralia
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hematology, University of Milan, Milan, Italy.,Advanced Screening Centers - ASC Italia, Castelli Calepio, Bergamo, Italy
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK
| | - Paola Pricolo
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Fabio Zugni
- Postgraduate School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Marco Martinetti
- Advanced Screening Centers - ASC Italia, Castelli Calepio, Bergamo, Italy
| | - Paul E Summers
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Luigi Grazioli
- First Department of Radiology, Civic and University Hospital of Brescia, Brescia, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Massimo Bellomi
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hematology, University of Milan, Milan, Italy.,Advanced Screening Centers - ASC Italia, Castelli Calepio, Bergamo, Italy
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Wang D, Huo Y, Chen S, Wang H, Ding Y, Zhu X, Ma C. Whole-body MRI versus 18F-FDG PET/CT for pretherapeutic assessment and staging of lymphoma: a meta-analysis. Onco Targets Ther 2018; 11:3597-3608. [PMID: 29950864 PMCID: PMC6016278 DOI: 10.2147/ott.s148189] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is the reference standard in staging of 18F-FDG-avid lymphomas; however, there is no recommended functional imaging modality for indolent lymphomas. Therefore, we aimed to compare the performance of whole-body magnetic resonance imaging (WB-MRI) with that of 18F-FDG PET/CT for lesion detection and initial staging in patients with aggressive or indolent lymphoma. Materials and methods We searched the MEDLINE, EMBASE, and CENTRAL databases for studies that compared WB-MRI with 18F-FDG PET/CT for lymphoma staging or lesion detection. The methodological quality of the studies was assessed using version 2 of the “Quality Assessment of Diagnostic Accuracy Studies” tool. The pooled staging accuracy (μ) of WB-MRI and 18F-FDG PET/CT for initial staging and for assessing possible heterogeneity (χ2) across studies were calculated using commercially available software. Results Eight studies comprising 338 patients were included. In terms of staging, the meta-analytic staging accuracies of WB-MRI and 18F-FDG PET/CT for Hodgkin lymphoma and aggressive non-Hodgkin lymphoma (NHL) were 98% (95% CI, 94%–100%) and 98% (95% CI, 94%–100%), respectively. The pooled staging accuracy of 18F-FDG PET/CT dropped to 87% (95% CI, 72%–97%) for staging in patients with indolent lymphoma, whereas that of WB-MRI remained 96% (95% CI, 91%–100%). Subgroup analysis indicated an even lower staging accuracy of 18F-FDG PET/CT for staging of less FDG-avid indolent NHLs (60%; 95% CI, 23%–92%), in contrast to the superior performance of WB-MRI (98%; 95% CI, 88%–100%). Conclusion WB-MRI is a promising radiation-free imaging technique that may serve as a viable alternative to 18F-FDG PET/CT for staging of 18FDG-avid lymphomas, where 18F-FDG PET/CT remains the standard of care. Additionally, WB-MRI seems a less histology-dependent functional imaging test than 18F-FDG PET/CT and may be the imaging test of choice for staging of indolent NHLs with low 18F-FDG avidity.
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Affiliation(s)
- Danyang Wang
- Department of Nuclear Medicine, Affiliated XinHua Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yanlei Huo
- Department of Nuclear Medicine, Affiliated XinHua Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Suyun Chen
- Department of Nuclear Medicine, Affiliated XinHua Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hui Wang
- Department of Nuclear Medicine, Affiliated XinHua Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yingli Ding
- Department of Nuclear Medicine, Affiliated Third People's Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaochun Zhu
- Department of Nuclear Medicine, Affiliated Ninth People's Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chao Ma
- Department of Nuclear Medicine, Affiliated XinHua Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Nuclear Medicine, Tenth People's Hospital of Tongji University, Shanghai, China
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Can diffusion-weighted whole-body MRI replace contrast-enhanced CT for initial staging of Hodgkin lymphoma in children and adolescents? Pediatr Radiol 2018; 48:638-647. [PMID: 29362839 DOI: 10.1007/s00247-018-4071-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/30/2017] [Accepted: 01/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although positron emission tomography with 18F-fluoro-2-deoxyglucose (FDG-PET/CT) has been recommended as the method of choice for lymphoma staging, it has limited availability in several countries, therefore, studies comparing whole-body magnetic resonance imaging (MRI) to conventional staging methods or to FDG-PET/CT are an important tool to establish whole-body MRI as an alternative to these methods. OBJECTIVE To compare whole-body MRI versus conventional imaging methods for staging of Hodgkin lymphoma in children and adolescents. MATERIALS AND METHODS The study included 22 patients ages 5 to 21 years. Staging was performed using conventional imaging methods and whole-body MRI. Conventional imaging methods were defined as computed tomography (CT) of the neck, chest, abdomen and pelvis and ultrasonography of the neck and/or abdomen. We calculated the sensitivity of these methods for Hodgkin lymphoma staging and their sensitivity and specificity for detecting sites of nodal and extranodal involvement. RESULTS The sensitivity of whole-body MRI for Hodgkin lymphoma staging was superior to that of conventional imaging methods (95.5% vs. 86.4%, respectively), but both methods had similar sensitivity and specificity for detecting involvement of nodal sites (99.1% and 100% vs. 97.3% and 100%, respectively) and extranodal sites (90.5% and 98.7% vs. 90.5% and 99.4%, respectively). CONCLUSION Whole-body MRI has excellent sensitivity for staging of Hodgkin lymphoma in children and adolescents. It can thus be considered an alternative for this purpose, particularly because it does not expose patients to ionizing radiation.
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De Paepe KN, De Keyzer F, Wolter P, Bechter O, Dierickx D, Janssens A, Verhoef G, Oyen R, Vandecaveye V. Improving lymph node characterization in staging malignant lymphoma using first-order ADC texture analysis from whole-body diffusion-weighted MRI. J Magn Reson Imaging 2018; 48:897-906. [DOI: 10.1002/jmri.26034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/17/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
| | | | - Pascal Wolter
- Department of Medical Oncology; University Hospitals Leuven; Belgium
| | - Oliver Bechter
- Department of Medical Oncology; University Hospitals Leuven; Belgium
| | - Daan Dierickx
- Department of Hematology; University Hospitals Leuven; Belgium
| | - Ann Janssens
- Department of Hematology; University Hospitals Leuven; Belgium
| | - Gregor Verhoef
- Department of Hematology; University Hospitals Leuven; Belgium
| | - Raymond Oyen
- Deparment of Radiology; University Hospitals Leuven; Belgium
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Fitzpatrick JJ, Ryan MA, Bruzzi JF. Diagnostic accuracy of diffusion-weighted imaging- magnetic resonance imaging compared to positron emission tomography/computed tomography in evaluating and assessing pathological response to treatment in adult patients with lymphoma: A systematic review. J Med Imaging Radiat Oncol 2018; 62:530-539. [PMID: 29577630 DOI: 10.1111/1754-9485.12723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 02/20/2018] [Indexed: 12/19/2022]
Abstract
The use of Positron emission tomography/computerised tomography (PET/CT) is well established in the staging and assessment of treatment response of lymphoma. Recent studies have suggested that whole body diffusion-weighted imaging -magnetic resonance imaging (WB-DW-MRI) may be an alternative to PET/CT in both staging and assessment of treatment response. A systematic review was performed to assess the ability of DW-MRI in the assessment of treatment response in lymphoma. Pubmed, Medline, Web of Science and Embase databases were queried for studies examining whole body DW-MRI compared to PET/CT in adult patients using a protocol of search terms. We carried out an extensive assessment of titles, abstracts and full texts of relevant paper as well as quality assessment with the Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool. Eight studies were found to meet the criteria and were included in our review and analysis. Overall, the quality of studies was found to be moderate, with good inter-rater agreement (K = 0.74). Data analysis showed that lesion-based assessment in 5 studies with pooled results had a sensitivity and specificity of 94.7% and 99.3%. Assessment with Cohen's Kappa coefficient showed agreement to be excellent (K = 0.88). Three studies were included for qualitative analysis, two of which showed good equivalence between PET/CT and DW-MRI. WB-DWI-MRI can be considered a sensitive and specific method for assessing treatment response in Lymphoma without the use of ionising radiation or administration of F-18 Flurodeoxyglucose. Further studies are needed to evaluate the optimum b-values in assessing treatment response.
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Stecco A, Buemi F, Iannessi A, Carriero A, Gallamini A. Current concepts in tumor imaging with whole-body MRI with diffusion imaging (WB-MRI-DWI) in multiple myeloma and lymphoma. Leuk Lymphoma 2018; 59:2546-2556. [PMID: 29431555 DOI: 10.1080/10428194.2018.1434881] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Whole-body MRI (WB-MRI) with diffusion-weighted imaging (DWI) can now be used to stage and restage multiple myeloma (MM) and lymphoma. Magnetic resonance imaging (MRI) is the standard tool to detect BM involvement (BMI). The 2016 diagnostic criteria of the International Myeloma Working Group identify WB-MRI and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) as the most sensitive imaging techniques for detecting skeletal and extra-skeletal MM invasion, respectively. Preliminary findings have also shown that WB-MRI is better than CT and equal to PET/CT in staging aggressive lymphoma and Hodgkin lymphoma, whereas MRI is better for diagnosing BMI in patients with low-grade lymphoma. Signal intensity (SI) and the apparent diffusion coefficient (ADC) are useful metrics to quantify the chemotherapy response in WB-MRI.
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Affiliation(s)
- Alessandro Stecco
- a Services Diagnosis and Therapies Department - Radiology , Azienda Ospedaliero-Universitaria Maggiore della Carita , Novara , Italy
| | - Francesco Buemi
- b Radiologic Department , L'Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte , Messina , Italy
| | - Antoine Iannessi
- c Radiology Department , Centre Antoine-Lacassagne , Nice , France
| | - Alessandro Carriero
- a Services Diagnosis and Therapies Department - Radiology , Azienda Ospedaliero-Universitaria Maggiore della Carita , Novara , Italy
| | - Andrea Gallamini
- d Research, Innovation and Statistics Department , Centre Antoine-Lacassagne , Nice , France
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Wu R, Suo ST, Wu LM, Yao QY, Gong HX, Xu JR. Assessment of chemotherapy response in non-Hodgkin lymphoma involving the neck utilizing diffusion kurtosis imaging: a preliminary study. Diagn Interv Radiol 2018; 23:245-249. [PMID: 28381389 DOI: 10.5152/dir.2017.16184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE We aimed to examine the utility of non-Gaussian diffusion kurtosis imaging (DKI) for assessment of chemotherapy response in patients with cervical (neck) non-Hodgkin lymphoma (NHL). METHODS Patients with cervical NHL underwent 3.0 T magnetic resonance imaging with maximal b value of 2000 s/mm2 at baseline and seven days after chemotherapy onset. Apparent diffusion coefficient (ADC) value and diffusion kurtosis imaging maps for diffusion coefficient (D) and kurtosis (K) were calculated. Based on clinical examination, laboratory screening, and PET/CTs, patients were classified as responders or nonresponders. RESULTS Twenty-six patients were enrolled. Among them, 24 patients were classified as responders and two as nonresponders. For responders, mean follow-up ADC and D increased significantly compared with baseline (ADC: 0.92±0.11 ×10-3 mm2/s vs. 0.68±0.11 ×10-3 mm2/s; D: 1.47±0.32 ×10-3 mm2/s vs. 0.98±0.21 ×10-3 mm2/s, P < 0.001 for both). Mean follow-up K decreased significantly compared with baseline (1.14±0.10 vs. 1.47±0.19, P < 0.001) for responders. Dratio showed significant positive correlation and high agreement with ADCratio (r = 0.776, P < 0.001). Likewise, Kratio showed significant negative correlation and high agreement with ADCratio (r = -0.658, P < 0.001). CONCLUSION The new DKI model may serve as a new biomarker for the evaluation of early chemotherapy response in NHL.
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Affiliation(s)
- Rui Wu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Morone M, Bali MA, Tunariu N, Messiou C, Blackledge M, Grazioli L, Koh DM. Whole-Body MRI: Current Applications in Oncology. AJR Am J Roentgenol 2017; 209:W336-W349. [PMID: 28981354 DOI: 10.2214/ajr.17.17984] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this article is to review current image acquisition and interpretation for whole-body MRI, clinical applications, and the emerging roles in oncologic imaging, especially in the assessment of bone marrow diseases. CONCLUSION Whole-body MRI is an emerging technique used for early diagnosis, staging, and assessment of therapeutic response in oncology. The improved accessibility and advances in technology, including widely available sequences (Dixon and DWI), have accelerated its deployment and acceptance in clinical practice.
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Affiliation(s)
- Mario Morone
- 1 Prima Radiologia Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Piazzale Spedali Civili, 1, Brescia, BS 25123, Italy
| | | | - Nina Tunariu
- 2 Radiology Department, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Christina Messiou
- 2 Radiology Department, Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - Luigi Grazioli
- 1 Prima Radiologia Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Piazzale Spedali Civili, 1, Brescia, BS 25123, Italy
| | - Dow-Mu Koh
- 2 Radiology Department, Royal Marsden NHS Foundation Trust, Sutton, UK
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Application of DWIBS in malignant lymphoma: correlation between ADC values and Ki-67 index. Eur Radiol 2017; 28:1701-1708. [PMID: 29143105 DOI: 10.1007/s00330-017-5135-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We investigated the correlation between the apparent diffusion coefficient (ADC) and Ki-67 index using diffusion-weighted whole-body imaging with background body signal suppression (DWIBS), and their utility in evaluating malignant lymphoma cell proliferation. MATERIALS AND METHODS Seventy-four patients with malignant lymphoma underwent DWIBS within 1 week before pathological confirmation. The ADC value was measured at the site of the pathological examination, and specimens were also stained with Ki-67. The ADC values and Ki-67 indices in aggressive non-Hodgkin's lymphoma (NHL), indolent NHL, and Hodgkin's lymphoma (HL) were compared using Spearman's rank correlation coefficient and the Kruskal-Wallis test. RESULTS The Ki-67 indices and ADC values were inversely correlated (r = -0.289, p = 0.0125); the differences in the Ki-67 index between aggressive NHL, indolent NHL, and HL were significant (p < 0.001); this was confirmed by the Nemenyi test except for indolent NHL vs. HL. The ADC values were significantly different between the types of lymphoma (p = 0.013); the Nemenyi test showed a significant difference only between aggressive NHL and HL. CONCLUSIONS The Ki-67 indices and ADC values are inversely correlated in patients with lymphoma, combining DWIBS and ADC values can evaluate the proliferation level of malignant lymphoma cells noninvasively. KEY POINTS • By using DWIBS, malignant lymphoma cell proliferation can be assessed noninvasively. • The ADC value and Ki-67 index are significantly and inversely correlated. • The ADC values were lower in aggressive NHL than in HL. • The ADC values of aggressive and indolent NHL were not significantly different.
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Huang J, Luo J, Peng J, Yang T, Zheng H, Mao C. Cerebral schistosomiasis: diffusion-weighted imaging helps to differentiate from brain glioma and metastasis. Acta Radiol 2017; 58:1371-1377. [PMID: 28090792 DOI: 10.1177/0284185116687173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Diffusion-weighted imaging (DWI) was introduced into clinical use some years ago. However, its use in the diagnosis of cerebral schistosomiasis has not been reported. Purpose To investigate the ability of the apparent diffusion coefficient (ADC) value of DWI in the diagnosis of cerebral schistosomiasis, and to differentiate it from brain high-grade gliomas and metastasis. Material and Methods Conventional brain MRI with pre-contrast, post-contrast, and DWI was performed on 50 cases of cerebral schistosomiasis, high-grade glioma, and brain metastasis. The ADC values of the three lesions, the proximal and the distal perifocal edema were measured. In order to remove the individual difference effect of ADC values, relative ADC (rADC) values were calculated through dividing the ADC value of the lesion area by that of the contralateral normal white matter. rADC values were used to evaluate the differences among cerebral schistosomiasis, brain high-grade gliomas, and metastasis. Results rADC of cerebral schistosomiasis was significantly lower than rADC of brain metastasis ( P < 0.05), without any significant differences when compared with high-grade gliomas. rADC of proximal perifocal edema in cerebral schistosomiasis was significantly higher than in high-grade gliomas ( P < 0.010), but not different compared with brain metastasis. Conclusion DWI examination with ADC values of lesions and proximal perifocal edema might be helpful in the exact diagnosis of cerebral schistosomiasis.
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Affiliation(s)
- Jinbai Huang
- Clinical Medical College of Yangtze University, Radiology Department of the First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, PR China
| | - Jing Luo
- Clinical Medical College of Yangtze University, Radiology Department of the First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, PR China
| | - Jie Peng
- Clinical Medical College of Yangtze University, Radiology Department of the First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, PR China
| | - Tao Yang
- Clinical Medical College of Yangtze University, Neurology Department of the First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, PR China
| | - Huanghua Zheng
- Clinical Medical College of Yangtze University, Radiology Department of the First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, PR China
| | - Chunping Mao
- Clinical Medical College of Yangtze University, Radiology Department of the First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, PR China
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Cottereau AS, Mulé S, Lin C, Belhadj K, Vignaud A, Copie-Bergman C, Boyez A, Zerbib P, Tacher V, Scherman E, Haioun C, Luciani A, Itti E, Rahmouni A. Whole-Body Diffusion-weighted MR Imaging of Iron Deposits in Hodgkin, Follicular, and Diffuse Large B-Cell Lymphoma. Radiology 2017; 286:560-567. [PMID: 28985135 DOI: 10.1148/radiol.2017170599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Purpose To analyze the frequency and distribution of low-signal-intensity regions (LSIRs) in lymphoma lesions and to compare these to fluorodeoxyglucose (FDG) uptake and biologic markers of inflammation. Materials and Methods The authors analyzed 61 untreated patients with a bulky lymphoma (at least one tumor mass ≥7 cm in diameter). When a LSIR within tumor lesions was detected on diffusion-weighted images obtained with a b value of 50 sec/mm2, a T2-weighted gradient-echo (GRE) sequence was performed and calcifications were searched for with computed tomography (CT). In two patients, Perls staining was performed on tissue samples from the LSIR. LSIRs were compared with biologic inflammatory parameters and baseline FDG positon emission tomography (PET)/CT parameters (maximum standardized uptake value [SUVmax], total metabolic tumor volume [TMTV]). Results LSIRs were detected in 22 patients and corresponded to signal void on GRE images; one LSIR was due to calcifications, and three LSIRS were due to a recent biopsy. In 18 patients, LSIRs appeared to be related to focal iron deposits; this was proven with Perls staining in two patients. The LSIRs presumed to be due to iron deposits were found mostly in patients with aggressive lymphoma (nine of 26 patients with Hodgkin lymphoma and eight of 20 patients with diffuse large B-cell lymphoma vs one of 15 patients with follicular lymphoma; P = .047) and with advanced stage disease (15 of 18 patients). LSIRS were observed in spleen (n = 14), liver (n = 3), and nodal (n = 8) lesions and corresponded to foci FDG uptake, with mean SUVmax of 9.8, 6.7, and 16.2, respectively. These patients had significantly higher serum levels of C-reactive protein, α1-globulin, and α2-globulin and more frequently had microcytic anemia than those without such deposits (P = .0072, P = .003, P = .0068, and P < .0001, respectively). They also had a significantly higher TMTV (P = .0055) and higher levels of spleen involvement (P < .0001). Conclusion LSIRs due to focal iron deposits are detected in lymphoma lesions and are associated with a more pronounced biologic inflammatory syndrome. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Anne-Ségolène Cottereau
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Sébastien Mulé
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Chieh Lin
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Karim Belhadj
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Alexandre Vignaud
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Christiane Copie-Bergman
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Alice Boyez
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Pierre Zerbib
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Vania Tacher
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Elodie Scherman
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Corinne Haioun
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Alain Luciani
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Emmanuel Itti
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Alain Rahmouni
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
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Whole body MRI with qualitative and quantitative analysis of DWI for assessment of bone marrow involvement in lymphoma. Radiol Med 2017; 122:623-632. [PMID: 28421406 DOI: 10.1007/s11547-017-0762-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/30/2017] [Indexed: 01/21/2023]
Abstract
AIM Our study aimed to investigate the role of qualitative and quantitative whole body MRI with DWI for assessment of bone marrow involvement (BMI) in newly diagnosed lymphoma using FDG PET-CT and bone marrow biopsy (BMB) as reference standard. MATERIALS AND METHODS We retrospectively evaluated 56 patients with newly diagnosed lymphoma (21 Hodgkin's lymphoma and 35 non-Hodgkin's lymphoma) who underwent random unilateral BMB, FDG PET-CT and Wb-MRI-DWI for initial staging. In a patient-based analysis, results of Wb-MRI-DWI were compared with FDG PET-CT and BMB. For quantitative analysis, mean ADC values of posterior iliac crest were correlated with BMI and bone marrow cellularity. RESULTS WB-MR-DWI obtained excellent concordance with FDG PET-CT both in HL (k = 1.000; 95% CI 1.000-1.000) and in DLBCL (k = 1.000; 95% CI 1.000-1.000). In other NHL, WB-MRI-DWI obtained a good correlation with BMB (k = 0.611; 95% CI 0.295-0.927) while FDG PET-CT had poor concordance (k = 0.067; 95% CI 0.372-0.505). WB-MR-DWI has no false negative errors but 4 false positive results consisting in focal lesions consensually reported by FDG PET-CT and resolved after therapy. No significant correlation between ADC mean value and BMI was found (p = 0.0586). CONCLUSION Our data suggest that Wb-MRI-DWI is a valid technique for BMI assessment in lymphoma patients, thanks to its excellent concordance with FDG PET-CT and good concordance with BMB (superior than FDG PET-CT). If further investigations will confirm our results on larger patient groups, it could become a useful tool in the clinical workup.
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Carlbom L, Caballero-Corbalán J, Granberg D, Sörensen J, Eriksson B, Ahlström H. Whole-body MRI including diffusion-weighted MRI compared with 5-HTP PET/CT in the detection of neuroendocrine tumors. Ups J Med Sci 2017; 122:43-50. [PMID: 27894208 PMCID: PMC5361431 DOI: 10.1080/03009734.2016.1248803] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIM We wanted to explore if whole-body magnetic resonance imaging (MRI) including diffusion-weighted (DW) and liver-specific contrast agent-enhanced imaging could be valuable in lesion detection of neuroendocrine tumors (NET). [11C]-5-Hydroxytryptophan positron emission tomography/computed tomography (5-HTP PET/CT) was used for comparison. MATERIALS AND METHODS Twenty-one patients with NET were investigated with whole-body MRI, including DW imaging (DWI) and contrast-enhanced imaging of the liver, and whole-body 5-HTP PET/CT. Seven additional patients underwent upper abdomen MRI including DWI, liver-specific contrast agent-enhanced imaging, and 5-HTP PET/CT. RESULTS There was a patient-based concordance of 61% and a lesion-based concordance of 53% between the modalities. MRI showed good concordance with PET in detecting bone metastases but was less sensitive in detecting metastases in mediastinal lymph nodes. MRI detected more liver metastases than 5-HTP PET/CT. CONCLUSION Whole-body MRI with DWI did not detect all NET lesions found with whole-body 5-HTP PET/CT. Our findings indicate that MRI of the liver including liver-specific contrast agent-enhanced imaging and DWI could be a useful complement to whole-body 5-HTP PET/CT.
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Affiliation(s)
- Lina Carlbom
- Institute of Surgical Sciences, Department of Radiology, Uppsala University, Uppsala, Sweden
| | | | - Dan Granberg
- Department of Medical Sciences. Uppsala University, Uppsala, Sweden
| | - Jens Sörensen
- Institute of Surgical Sciences, Department of Radiology, Uppsala University, Uppsala, Sweden
| | - Barbro Eriksson
- Department of Medical Sciences. Uppsala University, Uppsala, Sweden
| | - Håkan Ahlström
- Institute of Surgical Sciences, Department of Radiology, Uppsala University, Uppsala, Sweden
- CONTACT Håkan Ahlström Institute of Surgical Sciences, Department of Radiology, Entrance 70, 2nd floor, Uppsala University, Uppsala University Hospital, SE-75185, Uppsala. Sweden
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Abstract
PURPOSE To review how PET/MR technology could add value for pediatric cancer patients. RECENT FINDINGS Since many primary tumors in children are evaluated with MRI and metastases are detected with PET/CT, integrated PET/MR can be a time-efficient and convenient solution for pediatric cancer staging. 18F-FDG PET/MR can assess primary tumors and the whole body in one imaging session, avoid repetitive anesthesia and reduce radiation exposure compared to 18F-FDG PET/CT. This article lists 10 action points, which might improve the clinical value of PET/MR for children with cancer. However, even if PET/MR proves valuable, it cannot enter mainstream applications if it is not accessible to the majority of pediatric cancer patients. Therefore, innovations are needed to make PET/MR scanners affordable and increase patient throughput. SUMMARY PET/MR offers opportunities for more efficient, accurate and safe diagnoses of pediatric cancer patients. The impact on patient management and outcomes has to be substantiated by large-scale prospective clinical trials.
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Affiliation(s)
- Heike Daldrup-Link
- Department of Radiology, Lucile Packard Children's Hospital, and Pediatric Molecular Imaging Program (@PedsMIPS) in the Molecular Imaging Program at Stanford (MIPS), Stanford University
- Department of Pediatrics, Stanford University
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Can Interim 18F-FDG PET or Diffusion-Weighted MRI Predict End-of-Treatment Outcome in FDG-Avid MALT Lymphoma After Rituximab-Based Therapy?: A Preliminary Study in 15 Patients. Clin Nucl Med 2017; 41:837-843. [PMID: 27648705 DOI: 10.1097/rlu.0000000000001395] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine whether interim F-FDG PET or interim diffusion-weighted magnetic resonance imaging (DWI) can predict the end-of-treatment (EOT) outcome after immunotherapy in patients with FDG-avid extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT). MATERIALS AND METHODS Patients with untreated MALT lymphoma prospectively underwent whole-body F-FDG PET/CT and DWI before treatment (baseline), and after three cycles (interim) of rituximab-based immunotherapy. Maximum and mean standardized uptake values (SUVmax, SUVmean), and minimum and mean apparent diffusion coefficients (ADCmin, ADCmean), were measured for up to three target lesions per patient. Rates of change between baseline and interim examinations (ΔSUVmax, ΔSUVmean, ΔADCmin, and ΔADCmean) were compared, using ANOVAs, between the four end-of-treatment (EOT, after six cycles of immunotherapy) outcomes: complete remission (CR), partial remission (PR), stable disease (SD), or progressive disease (PD). RESULTS Fifteen patients with 25 lesions were included. Lesion-based post hoc tests showed significant differences between CR and PR for ΔSUVmax (P < 0.001), ΔSUVmean (P < 0.001), and ΔADCmin (P = 0.044), and between CR and SD for ΔSUVmax (P < 0.001), ΔSUVmean (P < 0.001), ΔADCmin (P = 0.021), and ΔADCmean (P = 0.022). No lesion showed PD at EOT. CONCLUSIONS Both quantitative interim F-FDG PET and interim DWI may possibly be useful to predict complete remission at end-of-treatment in MALT lymphoma patients after immunotherapy.
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18F-Fluorodeoxyglucose Positron Emission Tomography/Magnetic Resonance in Lymphoma: Comparison With 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and With the Addition of Magnetic Resonance Diffusion-Weighted Imaging. Invest Radiol 2016; 51:163-9. [PMID: 26784400 PMCID: PMC4747979 DOI: 10.1097/rli.0000000000000218] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objectives The aim of this study was to compare 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/magnetic resonance (MR) (with and without diffusion-weighted imaging [DWI]) to 18F-FDG PET/computed tomography (CT), with regard to the assessment of nodal and extranodal involvement, in patients with Hodgkin lymphoma and non-Hodgkin lymphoma, without restriction to FDG-avid subytpes. Materials and Methods Patients with histologically proven lymphoma were enrolled in this prospective, institutional review board–approved study. After a single 18F-FDG injection, patients consecutively underwent 18F-FDG PET⁄CT and 18F-FDG PET/MR on the same day for staging or restaging. Three sets of images were analyzed separately: 18F-FDG PET/CT, 18F-FDG PET/MR without DWI, and 18F-FDG PET/MR with DWI. Region-based agreement and examination-based sensitivity and specificity were calculated for 18F-FDG PET/CT, 18F-FDG PET/MR without DWI, and 18F-FDG PET/MR DWI. Maximum and mean standardized uptake values (SUVmax, SUVmean) on 18F-FDG PET/CT and 18F-FDG PET/MR were compared and correlated with minimum and mean apparent diffusion coefficients (ADCmin, ADCmean). Results Thirty-four patients with a total of 40 examinations were included. Examination-based sensitivities for 18F-FDG PET/CT, 18F-FDG PET/MR, and 18F-FDG PET/MR DWI were 82.1%, 85.7%, and 100%, respectively; specificities were 100% for all 3 techniques; and accuracies were 87.5%, 90%, and 100%, respectively. 18F-FDG PET/CT was false negative in 5 of 40 examinations (all with mucosa-associated lymphoid tissue lymphoma), and 18F-FDG PET/MR (without DWI) was false negative in 4 of 40 examinations. Region-based percentages of agreement were 99% (κ, 0.95) between 18F-FDG PET/MR DWI and 18F-FDG PET/CT, 99.2% (κ, 0.96) between 18F-FDG PET/MR and 18F-FDG PET/CT, and 99.4% (κ, 0.97) between 18F-FDG PET/MR DWI and 18F-FDG PET/MR. There was a strong correlation between 18F-FDG PET/CT and 18F-FDG PET/MR for SUVmax (r = 0.83) and SUVmean (r = 0.81) but no significant correlation between ADCmin and SUVmax (18F-FDG PET/CT: r = 0.46, P = 0.65; 18F-FDG PET/MR: r = 0.64, P = 0.53) or between ADCmean and SUVmean (respectively, r = −0.14, P = 0.17 for the correlation with PET/CT and r = −0.14, P = 0.14 for the correlation with PET/MR). Conclusions 18F-FDG PET/MR and 18F-FDG PET/CT show a similar diagnostic performance in lymphoma patients. However, if DWI is included in the 18F-FDG PET/MR protocol, results surpass those of 18F-FDG PET/CT because of the higher sensitivity of DWI for mucosa-associated lymphoid tissue lymphomas.
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Asenbaum U, Nolz R, Karanikas G, Furtner J, Woitek R, Staudenherz A, Senn D, Raderer M, Weber M, Simonitsch-Klupp I, Mayerhoefer ME. Evaluation of [18F]-FDG-Based Hybrid Imaging Combinations for Assessment of Bone Marrow Involvement in Lymphoma at Initial Staging. PLoS One 2016; 11:e0164118. [PMID: 27723817 PMCID: PMC5056699 DOI: 10.1371/journal.pone.0164118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/20/2016] [Indexed: 01/03/2023] Open
Abstract
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.
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Affiliation(s)
- Ulrika Asenbaum
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Richard Nolz
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Georgios Karanikas
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Julia Furtner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ramona Woitek
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Anton Staudenherz
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Daniela Senn
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Markus Raderer
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ingrid Simonitsch-Klupp
- Department of Internal Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Marius E. Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Abstract
PET/computed tomography (PET/CT) is an established hybrid imaging technique for staging and follow-up of gastrointestinal (GI) tract malignancies, especially for colorectal carcinoma. Dedicated hybrid PET/MR imaging scanners are currently available for clinical use. Although they will not replace regular use of PET/CT, they may have utility in selected cases of GI tract malignancies. The superior soft tissue contrast resolution and depiction of anatomy and the functional information obtained from diffusion-weighted imaging (DWI) provided by MR imaging in PET/MR imaging are advantages over CT of PET/CT for T staging and follow-up of rectal carcinoma and for better characterization of liver lesions. Functional information from DWI and use of liver-specific MR imaging contrast agents are an added advantage in follow-up of liver metastases after systemic and locoregional treatment. New radiotracers will improve the utility of PET/MR imaging in staging and follow-up of tumors, which may not be [18F]-2-fluoro-2-deoxy-d-glucose avid, such as hepatocellular carcinoma and neuroendocrine tumors. PET/MR imaging also has application in selected cases of cholangiocarcinoma, gallbladder cancer, and pancreatic carcinoma for initial staging and follow-up assessment.
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Affiliation(s)
- Raj Mohan Paspulati
- Division of Abdominal Imaging, Department of Radiology, University Hospitals Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Amit Gupta
- Department of Radiology, University Hospitals Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Atkinson W, Catana C, Abramson JS, Arabasz G, McDermott S, Catalano O, Muse V, Blake MA, Barnes J, Shelly M, Hochberg E, Rosen BR, Guimaraes AR. Hybrid FDG-PET/MR compared to FDG-PET/CT in adult lymphoma patients. Abdom Radiol (NY) 2016; 41:1338-48. [PMID: 27315095 DOI: 10.1007/s00261-016-0638-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE The goal of this study is to evaluate the diagnostic performance of simultaneous FDG-PET/MR including diffusion compared to FDG-PET/CT in patients with lymphoma. METHODS Eighteen patients with a confirmed diagnosis of non-Hodgkin's (NHL) or Hodgkin's lymphoma (HL) underwent an IRB-approved, single-injection/dual-imaging protocol consisting of a clinical FDG-PET/CT and subsequent FDG-PET/MR scan. PET images from both modalities were reconstructed iteratively. Attenuation correction was performed using low-dose CT data for PET/CT and Dixon-MR sequences for PET/MR. Diffusion-weighted imaging was performed. SUVmax was measured and compared between modalities and the apparent diffusion coefficient (ADC) using ROI analysis by an experienced radiologist using OsiriX. Strength of correlation between variables was measured using the Pearson correlation coefficient (r p). RESULTS Of the 18 patients included in this study, 5 had HL and 13 had NHL. The median age was 51 ± 14.8 years. Sixty-five FDG-avid lesions were identified. All FDG-avid lesions were visible with comparable contrast, and therefore initial and follow-up staging was identical between both examinations. SUVmax from FDG-PET/MR [(mean ± sem) (21.3 ± 2.07)] vs. FDG-PET/CT (mean 23.2 ± 2.8) demonstrated a strongly positive correlation [r s = 0.95 (0.94, 0.99); p < 0.0001]. There was no correlation found between ADCmin and SUVmax from FDG-PET/MR [r = 0.17(-0.07, 0.66); p = 0.09]. CONCLUSION FDG-PET/MR offers an equivalent whole-body staging examination as compared with PET/CT with an improved radiation safety profile in lymphoma patients. Correlation of ADC to SUVmax was weak, understating their lack of equivalence, but not undermining their potential synergy and differing importance.
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Affiliation(s)
- Wendy Atkinson
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Ciprian Catana
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Jeremy S Abramson
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Grae Arabasz
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Shanaugh McDermott
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Onofrio Catalano
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Victorine Muse
- Division of Thoracic Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Michael A Blake
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Jeffrey Barnes
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Martin Shelly
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Ephraim Hochberg
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Bruce R Rosen
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Alexander R Guimaraes
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA.
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA.
- Division of Body Imaging, Department of Diagnostic Radiology, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd., Mail Code L340, Portland, OR, 97239, USA.
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Grueneisen J, Sawicki LM, Schaarschmidt BM, Suntharalingam S, von der Ropp S, Wetter A, Ruhlmann V, Quick HH, Forsting M, Umutlu L. Evaluation of a Fast Protocol for Staging Lymphoma Patients with Integrated PET/MRI. PLoS One 2016; 11:e0157880. [PMID: 27327617 PMCID: PMC4915683 DOI: 10.1371/journal.pone.0157880] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/06/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the applicability of a fast MR-protocol for whole-body staging of lymphoma patients using an integrated PET/MR system. METHODS A total of 48 consecutive lymphoma patients underwent 52 clinically indicated PET/CT and subsequent PET/MRI examinations with the use of 18F-FDG. For PET/MR imaging, a fast whole-body MR-protocol was implemented. A radiologist and a nuclear medicine physician interpreted MRI and PET/MRI datasets in consensus and were instructed to identify manifestations of lymphoma on a site-specific analysis. The accuracy for the identification of active lymphoma disease was calculated and the tumor stage for each examination was determined. Furthermore, radiation doses derived from administered tracer activities and CT protocol parameters were estimated and the mean scan duration of PET/CT and PET/MR imaging was determined. Statistical analysis was performed to compare the diagnostic performance of PET/MRI and MRI alone. The results of PET/CT imaging, all available histopathological samples as well as results of prior examinations and follow-up imaging were used for the determination of the reference standard. RESULTS Active lymphoma disease was present in 28/52 examinations. PET/MRI revealed higher values of diagnostic accuracy for the identification of active lymphoma disease in those 52 examinations in comparison to MRI, however, results of the two ratings did not differ significantly. On a site specific analysis, PET/MRI showed a significantly higher accuracy for the identification of nodal manifestation of lymphoma (p<0.05) if compared to MRI, whereas ratings for extranodal regions did not reveal a significant difference. In addition, PET/MRI enabled correct identification of lymphoma stage in a higher percentage of patients than MRI (94% vs. 83%). Furthermore, SUVs derived from PET/MRI were significantly higher than in PET/CT, however, there was a strong positive correlation between SUVmax and SUVmean of the two imaging modalities (R = 0.91 p<0.001 and R = 0.87, p<0.001). Average scan duration of whole-body PET/CT and PET/MRI examinations amounted to 17.3±1.9 min and 27.8±3.7 min, respectively. Estimated mean effective-dose for whole-body PET/CT scans were 64.4% higher than for PET/MRI. CONCLUSIONS Our results demonstrate the usefulness of 18F-FDG PET data as a valuable additive to MRI for a more accurate evaluation of patients with lymphomas. With regard to patient comfort related to scan duration and a markedly reduced radiation exposure, fast PET/MRI may serve as a powerful alternative to PET/CT for a diagnostic workup of lymphoma patients.
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Affiliation(s)
- Johannes Grueneisen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lino Morris Sawicki
- Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany
| | - Benedikt Michael Schaarschmidt
- Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany
| | - Saravanabavaan Suntharalingam
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sara von der Ropp
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Axel Wetter
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Verena Ruhlmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Harald H Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany.,High Field and Hybrid MR Imaging, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Whole-body MRI in patients with lymphoma: collateral findings. Radiol Med 2016; 121:793-800. [PMID: 27307001 DOI: 10.1007/s11547-016-0658-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/30/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess the incidence of collateral findings detected on whole-body magnetic resonance (WB-MRI) scans performed on patients with lymphoma. MATERIALS AND METHODS 114 patients (65 male; median age 45.2 years, range 15-86) with histologically confirmed lymphoma (47 Hodgkin, 67 Non-Hodgkin) underwent WB-MRI. The collateral findings were classified into three classes, according to their clinical significance, as follows: not or low significant (class 1), moderately or potentially significant (class 2), and significant (class 3). A Chi-square (χ (2)) test was performed to assess the statistical significance of differences in the incidence of collateral findings based on age (≤50 and >50 years old), gender and histology (Hodgkin and Non-Hodgkin Lymphoma). RESULTS Ninety-one of 114 patients (79.8 %) had one or more incidental findings on WB-MRI. Collateral findings were more frequent in class 1 (43 %); abnormalities found in 35 patients (30.7 %) were considered potentially significant, whereas seven patients (6.1 %) demonstrated significant collateral findings requiring immediate treatment or further diagnostic evaluation. Collateral findings were more frequent in subjects over 50 years old compared to those of 50 years old or younger; differences were statistical significant (χ (2) = 8.42, p < 0.05). There were not statistically significant differences related to gender (χ (2) = 0.17, p > 0.05) and histology (χ (2) = 0.24, p > 0.05). CONCLUSION WB-MRI is an attractive procedure that allows to detect incidental abnormalities of organs not involved by disease offering the opportunity to obtain an early diagnosis of asymptomatic life-threatening diseases.
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Sun M, Cheng J, Zhang Y, Wang F, Meng Y, Fu X. Application value of diffusion weighted whole body imaging with background body signal suppression in monitoring the response to treatment of bone marrow involvement in lymphoma. J Magn Reson Imaging 2016; 44:1522-1529. [PMID: 27160047 DOI: 10.1002/jmri.25300] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To investigate the application value of diffusion weighted whole body imaging with background body signal suppression (DWIBS) in monitoring the response to treatment of bone marrow involvement in lymphoma. MATERIALS AND METHODS Twenty-one lymphoma patients with bone marrow involvement underwent 1.5 Tesla DWIBS before chemotherapy and after the second chemotherapy session (median interval, 8 weeks; range 7-11 weeks). Apparent diffusion coefficient (ADC) values of bone marrow lesions were measured before and after treatment. The difference in ADC values before and after treatment in responders and nonresponders was analyzed. RESULTS Seventy-three cases of bone marrow lesions were diagnosed in 21 lymphoma patients before the treatment. After the second chemotherapy session, 18 patients (57 lesions) and 3 patients (9 lesions) were categorized into the responder and nonresponder group, respectively. The mean pretreatment ADC value of all lesions was 0.90 ± 0.39 × 10-3 mm2 /s, of which the mean ADC values of the responder group and nonresponder group were 0.92 ± 0.40 × 10-3 mm2 /s and 0.79 ± 0.29 × 10-3 mm2 /s, respectively (between-group difference: t = -0.94; P = 0.351). The posttreatment ADC value of the responder group significantly increased (66.39% ± 83.11%; P < 0.001) while the posttreatment ADC value of the nonresponder group slightly increased (5.32% ± 17.31%). The difference in the rate of change of ADC values in the responder and nonresponder groups before and after the treatment was significant (P < 0.05). CONCLUSION DWIBS in combination with the measurement of ADC values enabled a good short-term response evaluation for bone marrow involvement in lymphoma. However, the pretreatment ADC value indicated no significant predictive value for responses to the treatment. J. Magn. Reson. Imaging 2016;44:1522-1529.
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Affiliation(s)
- Mengtian Sun
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P. R. China
| | - Jingliang Cheng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P. R. China
| | - Yong Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P. R. China
| | - Feifei Wang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P. R. China
| | - Yun Meng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P. R. China
| | - Xiaorui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P. R. China
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Sotoudeh H, Sharma A, Fowler KJ, McConathy J, Dehdashti F. Clinical application of PET/MRI in oncology. J Magn Reson Imaging 2016; 44:265-76. [DOI: 10.1002/jmri.25161] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 12/31/2015] [Indexed: 12/19/2022] Open
Affiliation(s)
- Houman Sotoudeh
- Edward Mallinckrodt Institute of Radiology; Washington University School of Medicine; St. Louis Missouri USA
- Washington University School of Medicine; St. Louis Missouri USA
| | - Akash Sharma
- Edward Mallinckrodt Institute of Radiology; Washington University School of Medicine; St. Louis Missouri USA
- Washington University School of Medicine; St. Louis Missouri USA
| | - Kathryn J. Fowler
- Edward Mallinckrodt Institute of Radiology; Washington University School of Medicine; St. Louis Missouri USA
- Washington University School of Medicine; St. Louis Missouri USA
- Edward Mallinckrodt Institute of Radiology; Alvin J. Siteman Cancer Center; Washington University School of Medicine; St. Louis Missouri USA
| | - Jonathan McConathy
- Edward Mallinckrodt Institute of Radiology; Washington University School of Medicine; St. Louis Missouri USA
- Washington University School of Medicine; St. Louis Missouri USA
- Edward Mallinckrodt Institute of Radiology; Alvin J. Siteman Cancer Center; Washington University School of Medicine; St. Louis Missouri USA
| | - Farrokh Dehdashti
- Edward Mallinckrodt Institute of Radiology; Washington University School of Medicine; St. Louis Missouri USA
- Washington University School of Medicine; St. Louis Missouri USA
- Edward Mallinckrodt Institute of Radiology; Alvin J. Siteman Cancer Center; Washington University School of Medicine; St. Louis Missouri USA
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Abstract
With the introduction of hybrid imaging technologies such as PET/CT and recently PET/MRI, staging and therapy-response monitoring have evolved. PET/CT has been shown to be of value for routine staging of FDG-avid lymphomas before as well as at the end of treatment. For interim staging, trials are ongoing to evaluate the use of PET/CT. In melanoma, PET/CT can be recommended for stages III and IV diseases for initial staging and before surgery. Studies investigating the use of PET/CT for early therapy response are promising. The role of PET/MR in lymphoma and melanoma imaging has to be defined because no larger studies exist so far. There may be an application of PET/MR in research especially for tumor characterization and therapy response. Furthermore, the potential role of non-FDG tracers is elucidated regarding the assessment of treatment response in targeted drug regimens.
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Affiliation(s)
- Nina F Schwenzer
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Anna Christina Pfannenberg
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
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Balbo-Mussetto A, Cirillo S, Bruna R, Gueli A, Saviolo C, Petracchini M, Fornari A, Lario CV, Gottardi D, De Crescenzo A, Tarella C. Whole-body MRI with diffusion-weighted imaging: a valuable alternative to contrast-enhanced CT for initial staging of aggressive lymphoma. Clin Radiol 2015; 71:271-9. [PMID: 26749081 DOI: 10.1016/j.crad.2015.11.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 10/13/2015] [Accepted: 11/24/2015] [Indexed: 12/11/2022]
Abstract
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, and (18)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 from (18)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 using (18)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.
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Affiliation(s)
- A Balbo-Mussetto
- Radiology Division, Mauriziano-Umberto I Hospital, Torino, Italy.
| | - S Cirillo
- Radiology Division, Mauriziano-Umberto I Hospital, Torino, Italy
| | - R Bruna
- Hematology and Cell Therapy Division, Mauriziano-Umberto I Hospital & University, Torino, Italy
| | - A Gueli
- Hematology and Cell Therapy Division, Mauriziano-Umberto I Hospital & University, Torino, Italy
| | - C Saviolo
- Radiology Division, Mauriziano-Umberto I Hospital, Torino, Italy
| | - M Petracchini
- Radiology Division, Mauriziano-Umberto I Hospital, Torino, Italy
| | - A Fornari
- Radiology Division, Mauriziano-Umberto I Hospital, Torino, Italy
| | - C V Lario
- Radiology Division, Mauriziano-Umberto I Hospital, Torino, Italy
| | - D Gottardi
- Hematology and Cell Therapy Division, Mauriziano-Umberto I Hospital & University, Torino, Italy
| | - A De Crescenzo
- Hematology and Cell Therapy Division, Mauriziano-Umberto I Hospital & University, Torino, Italy
| | - C Tarella
- Hematology and Cell Therapy Division, Mauriziano-Umberto I Hospital & University, Torino, Italy
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Staging of Primary Abdominal Lymphomas: Comparison of Whole-Body MRI with Diffusion-Weighted Imaging and (18)F-FDG-PET/CT. Gastroenterol Res Pract 2015; 2015:104794. [PMID: 26798331 PMCID: PMC4700158 DOI: 10.1155/2015/104794] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/22/2015] [Accepted: 08/23/2015] [Indexed: 12/13/2022] Open
Abstract
Background. The purpose of this study was to compare the accuracy of whole-body MRI with diffusion-weighted sequences (WB-DW-MRI) with that of 18F-FDG-PET/CT in the staging of patients with primary gastrointestinal lymphoma. Methods. This retrospective study involved 17 untreated patients with primary abdominal gastrointestinal lymphoma. All patients underwent 18F-FDG-PET/CT and WB-DW-MRI. Histopathology findings or at least 6 months of clinical and radiological follow-up was the gold standard. The Musshoff-modified Ann Arbor system was used for staging, and diagnostic accuracy was evaluated on a per-node basis. Results. WB-DW-MRI exhibited 100% sensitivity, 96.3% specificity, and 96.1% and 100% positive and negative predictive values (PPV and NPV), respectively. The sensitivity, specificity, and PPV and NPV of PET/CT were 95.9%, 100%, and 100% and 96.4%, respectively. There were no statistically significant differences between the two techniques (p = 0.05). The weighted kappa agreement statistics with a 95% confidence interval were 0.97 (0.95–0.99) between the two MRI readers and 0.87 (0.82–0.92) between the two methods. Conclusions. WB-DW-MRI appears to have a comparable diagnostic value to 18F-FDG-PET/CT in staging patients with gastrointestinal lymphoma.
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Mosavi F, Laurell A, Ahlström H. Whole body MRI, including diffusion-weighted imaging in follow-up of patients with testicular cancer. Acta Oncol 2015; 54:1763-9. [PMID: 25975210 DOI: 10.3109/0284186x.2015.1043027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Whole body (WB) magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) has become increasingly utilized in cancer imaging, yet the clinical utility of these techniques in follow-up of testicular cancer patients has not been evaluated. The purpose of this study was to evaluate the feasibility of WB MRI with continuous table movement (CTM) technique, including multistep DWI in follow-up of patients with testicular cancer. PATIENTS AND METHODS WB MRI including DWI was performed in follow-up of 71 consecutive patients (median age, 37 years; range 19-84) with histologically confirmed testicular cancer. WB MRI protocol included axial T1-Dixon and T2-BLADE sequences using CTM technique. Furthermore, multi-step DWI was performed using b-value 50 and 1000 s/mm(2). One criterion for feasibility was patient tolerance and satisfactory image quality. Another criterion was the accuracy in detection of any pathological mass, compared to standard of reference. Signal intensity in DWI was used for evaluation of residual mass activity. Clinical, laboratory and imaging follow-up were applied as standard of reference for the evaluation of WB MRI. RESULTS WB MRI was tolerated in nearly all patients (69/71 patients, 97%) and the image quality was satisfactory. Metal artifacts deteriorated the image quality in six patients, but it did not influence the overall results. No case of clinical relapse was observed during the follow-up time. There was a good agreement between conventional WB MRI and standard of reference in all patients. Three patients showed residual masses and DWI signal was not restricted in these patients. Furthermore, DWI showed abnormally high signal intensity in a normal-sized retroperitoneal lymph node indicating metastasis. The subsequent (18)F-FDG PET/CT could verify the finding. CONCLUSION WB MRI with CTM technique including multi-step DWI is feasible in follow-up of patients with testicular cancer. DWI may contribute to important added-value data to conventional MRI sequences regarding the activity of residual masses.
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Affiliation(s)
- Firas Mosavi
- a Section of Radiology, Department of Radiology , Oncology and Radiation Science, Uppsala University Hospital , Uppsala , Sweden
| | - Anna Laurell
- b Section of Oncology, Department of Radiology , Oncology and Radiation Science, Uppsala University Hospital , Uppsala , Sweden
| | - Håkan Ahlström
- a Section of Radiology, Department of Radiology , Oncology and Radiation Science, Uppsala University Hospital , Uppsala , Sweden
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Maggialetti N, Ferrari C, Minoia C, Asabella AN, Ficco M, Loseto G, De Tullio G, de Fazio V, Calabrese A, Guarini A, Rubini G, Brunese L. Role of WB-MR/DWIBS compared to (18)F-FDG PET/CT in the therapy response assessment of lymphoma. Radiol Med 2015; 121:132-43. [PMID: 26349573 DOI: 10.1007/s11547-015-0581-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 08/25/2015] [Indexed: 12/18/2022]
Abstract
INTRODUCTION This study prospectively evaluated whole-body magnetic resonance/diffusion-weighted imaging with body signal suppression (WB-MR/DWIBS) reliability compared to (18)F-FDG PET/CT in the treatment response assessment of classic Hodgkin lymphomas (HL) and aggressive non-Hodgkin lymphomas (aNHL). MATERIALS AND METHODS Twenty-seven consecutive patients were prospectively enrolled at the time of diagnosis. Eighteen (11 HL and seven aNHL) were considered for the analysis. They received chemo/radiotherapy as induction and completed post-treatment evaluation performing both (18)F-FDG PET/CT and WB-MR/DWIBS. The revised response criteria for malignant lymphomas were used to assess the response to treatment. We evaluated the agreement between the two methods by Cohen's K test. Post-therapy WB-MR/DWIBS sensitivity, specificity, PPV, NPV and accuracy were then calculated, considering the 12 months of follow-up period as the gold standard. RESULTS By using an evaluation on a lesion-by-lesion basis, WB-MR/DWIBS and (18)F-FDG PET/CT showed an overall good agreement (K = 0.796, 95% IC = 0.651-0.941), especially in the evaluation of the nodal basins in aNHL (K = 0.937, 95% IC = 0.814-1). In reference to the revised response criteria for malignant lymphomas, the two methods showed a good agreement (K = 0.824, 95% IC = 0.493-1). Post-therapy sensitivity, specificity, PPV, NPV and accuracy of WB-MR/DWIBS were 43, 91, 75, 71 and 72%, respectively. CONCLUSION WB-MR/DWIBS seems to be an appropriate method for the post-treatment assessment of patients affected by HL and aNHL. The small discrepancies between the two methods found within HL could be due to the biological and metabolic behavior of this group of diseases. Larger prospective studies are necessary to better define the role of WB-MR/DWIBS in this setting of patients.
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Affiliation(s)
- Nicola Maggialetti
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
| | - Cristina Ferrari
- D.I.M.- Diagnostic Imaging - Nuclear Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Carla Minoia
- Department of Medical and Experimental Oncology, IRCCS National Cancer Research Centre "Giovanni Paolo II", Bari, Italy
| | - Artor Niccoli Asabella
- D.I.M.- Diagnostic Imaging - Nuclear Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Michele Ficco
- Department of Radiodiagnostic, IRCCS National Cancer Research Centre "Giovanni Paolo II", Bari, Italy
| | - Giacomo Loseto
- Department of Medical and Experimental Oncology, IRCCS National Cancer Research Centre "Giovanni Paolo II", Bari, Italy
| | - Giacomina De Tullio
- Department of Medical and Experimental Oncology, IRCCS National Cancer Research Centre "Giovanni Paolo II", Bari, Italy
| | - Vincenza de Fazio
- Department of Medical and Experimental Oncology, IRCCS National Cancer Research Centre "Giovanni Paolo II", Bari, Italy
| | - Angela Calabrese
- Department of Radiodiagnostic, IRCCS National Cancer Research Centre "Giovanni Paolo II", Bari, Italy
| | - Attilio Guarini
- Department of Medical and Experimental Oncology, IRCCS National Cancer Research Centre "Giovanni Paolo II", Bari, Italy
| | - Giuseppe Rubini
- D.I.M.- Diagnostic Imaging - Nuclear Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Luca Brunese
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
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Abstract
PET/MRI is a hybrid imaging modality that is gaining clinical interest with the first Food and Drug Administration-approved simultaneous imaging system recently added to the clinical armamentarium. Several advanced PET/MRI applications, such as high-resolution anatomic imaging, diffusion-weighted imaging, motion correction, and cardiac imaging, show great potential for clinical use. The purpose of this article is to highlight several advanced PET/MRI applications through case examples and review of the current literature.
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Grisold W, Grisold A, Marosi C, Meng S, Briani C. Neuropathies associated with lymphoma †. Neurooncol Pract 2015; 2:167-178. [PMID: 31386037 DOI: 10.1093/nop/npv025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Indexed: 12/12/2022] Open
Abstract
Neuropathy occurs with various manifestations as a consequence of lymphoma, and an understanding of the etiology is necessary for proper treatment. Advances in medical imaging have improved the detection of peripheral nerve involvement in lymphoma, yet tissue diagnosis is often equally important. The neoplastic involvement of the peripheral nervous system (PNS) in lymphoma can occur within the cerebrospinal fluid (CSF), inside the dura, or outside of the CSF space, affecting nerve root plexuses and peripheral nerves. The infiltration of either cranial or peripheral nerves in lymphoma is termed neurolymphomatosis (NL). These infiltrations can occur as mononeuropathy, multifocal neuropathy, symmetric neuropathies, or plexopathies. In rare cases, intravascular lymphoma (IL) can affect the PNS and an even rarer condition is the combination of NL and IL. Immune-mediated and paraneoplastic neuropathies are important considerations when treating patients with lymphoma. Demyelinating neuropathies, such as Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy, occur more frequently in non-Hodgkin's lymphoma than in Hodgkin's disease. Paraproteinemic neuropathies can be associated with lymphoma and paraneoplastic neuropathies are rare. While the treatment of lymphomas has improved, a knowledge of neurotoxic, radiotherapy, neoplastic, immune-mediated and paraneoplastic effects are important for patient care.
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Affiliation(s)
- Wolfgang Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
| | - Anna Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
| | - Christine Marosi
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
| | - Stefan Meng
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
| | - Chiara Briani
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
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Whole-body diffusion-weighted MRI and (18)F-FDG PET/CT can discriminate between different lymphoma subtypes. Clin Radiol 2015. [PMID: 26208992 DOI: 10.1016/j.crad.2015.06.087] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM To determine whether combined 2-[(18)F]-fluoro-2-deoxy-d-glucose ((18)F-FDG) positron-emission tomography (PET)/computed tomography (CT) and diffusion-weighted imaging (DWI) can be used for characterisation of different lymphoma subtypes, i.e., indolent versus aggressive lymphoma, and also to assess the prognostic value of different quantitative parameters of whole-body (WB) DWI and (18)F-FDG PET/CT. MATERIALS AND METHODS Pre-therapeutic WB magnetic resonance imaging (MRI) including DWI and (18)F-FDG PET/CT were performed in lymphoma patients. Different quantitative DWI and (18)F-FDG PET/CT parameters were evaluated for characterisation of different lymphoma subtypes. These parameters were also correlated, both separately and in combination, against overall survival (OS) and progression-free survival (PFS). A lesion-by-lesion analysis was performed for correlation analysis between maximum standardised uptake value (SUVmax), mean standardised uptake value (SUVmean) and mean apparent diffusion coefficient (ADC). RESULTS Fifty patients were included in the study and divided into three groups: Hodgkin's lymphoma (HL), n=12; aggressive non-Hodgkin's lymphoma (NHL), n=29 (including 20 patients with diffuse large B-cell lymphoma, DLBCL); and indolent NHL, n=9. Indolent NHL showed significantly lower mean ADC values than the other two lymphoma groups (p=0.013). Aggressive NHL had a higher SUVmax than HL. The OS analysis of all patients showed a relationship (p=0.006) between increased mean ADC and longer OS. A model with both SUVmean and mean ADC, strengthened the possibility to predict PFS; however, a separate analysis of the DLBCL patients showed that none of the quantitative parameters could predict OS or PFS. CONCLUSION ADC can discriminate between indolent and aggressive NHL. This finding can be useful in assessing possible transformation from indolent to aggressive NHL. ADC, ADC/SUV, and SUV cannot predict OS/PFS independent of lymphoma subtype.
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50
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Abstract
OBJECTIVE The objective of our study was to assess the role of recently introduced hybrid PET/MRI in the evaluation of lymphoma patients using PET/CT as a reference standard. SUBJECTS AND METHODS In this prospective study 28 consecutive lymphoma patients (18 men, 10 women; mean age, 53.6 years) undergoing clinically indicated PET/ CT were subsequently imaged with PET/MRI using residual FDG activity from the PET/ CT study. Blinded readers evaluated PET/CT (reference standard), PET/MRI, and diffusion-weighted imaging (DWI) studies separately; for each study, they assessed nodal and extranodal involvement. Each FDG-avid nodal station was marked and compared on DWI, PET/MRI, and PET/CT. Modified Ann Arbor staging was performed and compared between PET/MRI and PET/CT. The maximum standardized uptake value (SUVmax) on PET/MRI for FDG-avid nodal lesions was compared with the SUVmax on PET/CT. The apparent diffusion coefficient (ADC) for FDG-avid nodal lesions was compared to SUVmax on PET/MRI. RESULTS Fifty-one FDG-avid nodal groups were identified on PET/CT in 13 patients. PET/MRI identified 51 of these nodal groups with a sensitivity of 100%. DWI identified 32 nodal groups for a sensitivity of 62.7%. PET/MRI staging and PET/CT staging were concordant in 96.4% of patients. For the one patient with discordant staging results, disease was correctly upstaged to stage IV on the basis of the PET/MRI finding of bone marrow involvement, which was missed on PET/CT. DWI staging was concordant with PET/CT staging in 64.3% of the patients. The increased staging accuracy of PET/MRI relative to DWI was significant (p=0.004). SUVmax measured on PET/MRI and PET/CT showed excellent statistically significant correlation (r=0.98, p<0.001). There was a poor negative correlation between ADC and SUVmax (r=-0.036, p=0.847). CONCLUSION PET/MRI can be used to assess disease burden in lymphoma with sensitivity similar to PET/CT and can be a viable alternative for lymphoma staging and follow-up.
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