title: Whole-body MRI for initial staging of paediatric lymphoma: prospective comparison to an FDG-PET/CT-based reference standard.
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.
  
  
  CONCLUSIONS
  • 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.
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht/Wilhelmina Children's Hospital, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands, alittooij@hotmail.com.
authors.forename: Annemieke S
authors.initials: AS
authors.lastname: Littooij
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Kwee
authors.forename: Ignasi
authors.initials: I
authors.lastname: Barber
authors.forename: Claudio
authors.initials: C
authors.lastname: Granata
authors.forename: Malou A
authors.initials: MA
authors.lastname: Vermoolen
authors.forename: Goya
authors.initials: G
authors.lastname: Enríquez
authors.forename: József
authors.initials: J
authors.lastname: Zsíros
authors.forename: Shui Yen
authors.initials: SY
authors.lastname: Soh
authors.forename: Bart
authors.initials: B
authors.lastname: de Keizer
authors.forename: Frederik J A
authors.initials: FJ
authors.lastname: Beek
authors.forename: Monique G
authors.initials: MG
authors.lastname: Hobbelink
authors.forename: Marc B
authors.initials: MB
authors.lastname: Bierings
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.forename: Rutger A J
authors.initials: RA
authors.lastname: Nievelstein
mesh_terms: D000293:Adolescent; D002648:Child; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008223:Lymphoma / Q000000981:diagnostic imaging*; D008297:Male; D009367:Neoplasm Staging; D015588:Observer Variation; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012015:Reference Standards; D012680:Sensitivity and Specificity; D051598:Whole Body Imaging
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18