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Whole-body MRI for initial staging of paediatric lymphoma: prospective comparison to an FDG-PET/CT-based reference standard

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Abstract

Objective

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

Methods

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

Results

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

Conclusions

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

Keypoints

Accurate staging is important for treatment planning and assessing prognosis

Whole-body MRI-DWI could be a good radiation-free alternative to FDG-PET/CT

Interobserver agreement of whole-body MRI-DWI is good

Agreement between whole-body MRI and the FDG-PET/CT reference standard is good

Most discrepancies were caused by suboptimal accuracy of size measurements on MRI

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Acknowledgements

We would like to thank Willem P.T.M. Mali, MD, PhD, Department of Radiology, University Medical Centre Utrecht, for his contribution to this study.

Fourteen of 33 included patients were analysed in our previously published study (Kwee TC, Vermoolen MA, Akkerman EA et al. (2013) Whole-body MRI, including diffusion-weighted imaging, for staging lymphoma – comparison with CT in a prospective multicenter study. J Magn Reson Imaging DOI:10.1002/jmri.24356). In that previous analysis, however, whole-body MRI was compared to contrast-enhanced CT; no comparison was made with the FDG-PET/CT-based reference standard, and no analysis was done in the paediatric and adolescent subgroup. The present study provides substantial new information and allows drawing conclusions in this paediatric population.

The scientific guarantor of this publication is R.A.J. Nievelstein. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This project was financially supported by the Dutch Organisation of Health Research and Development (ZonMw) Programme for Health Care Efficiency Research (grant no. 80-82310-98-08012) and Kinderen Kankervrij (KIKA; project no. 87). Data collection, data analysis and interpretation of data, writing of the paper and the decision to submit were left to the authors’ discretion and were not influenced by ZonMw or KIKA. No complex statistical methods were necessary for this article. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, multicenter study

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Correspondence to Annemieke S. Littooij.

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Littooij, A.S., Kwee, T.C., Barber, I. et al. Whole-body MRI for initial staging of paediatric lymphoma: prospective comparison to an FDG-PET/CT-based reference standard. Eur Radiol 24, 1153–1165 (2014). https://doi.org/10.1007/s00330-014-3114-0

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  • DOI: https://doi.org/10.1007/s00330-014-3114-0

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