Evaluation of diffusion-weighted MRI for pretherapeutic assessment and staging of lymphoma: results of a prospective study in 140 patients.
OBJECTIVE
To determine the value of diffusion-weighted MRI (DWI-MRI) for pretherapeutic imaging of fluorodeoxyglucose (FDG)-avid lymphoma and lymphoma with variable FDG avidity.


METHODS
Treatment-naïve patients with lymphoma who were referred for whole-body staging were included in this prospective study. Group A included patients with FDG-avid lymphoma (e.g., Hodgkin, diffuse large B-cell, and follicular lymphoma), whereas Group B included patients with lymphoma of variable FDG avidity [e.g., extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT)]. All patients underwent DWI-MRI and 18F-FDG- positron emission tomography/computed tomography (PET/CT). Region-based sensitivity and agreement with Ann Arbor staging, relative to the reference standard, were calculated for DWI-MRI, and, in Group B, also 18F-FDG-PET/CT and contrast-enhanced (CE-) CT.


RESULTS
In Group A (100 patients), DWI-MRI had a region-based sensitivity of 97%, and with regard to staging, agreed with the reference standard in 94 of 100 patients (κ, 0.92). In Group B (40 patients; 38 MALT lymphomas and 2 small lymphocytic lymphomas/chronic lymphocytic leukemias), DWI-MRI, 18F-FDG-PET/CT, and CE-CT had region-based sensitivities of 94.4%, 60.9%, and 70.7%, respectively. With regard to staging in Group B, DWI-MRI, 18F-FDG-PET/CT, and CE-CT agreed with the reference standard in 37 of 40, 26 of 40, and 24 of 40 patients, with κ values of 0.89, 0.52, and 0.43, respectively.


CONCLUSIONS
In patients with FDG-avid lymphoma, DWI-MRI seems to be only slightly inferior to 18F-FDG-PET/CT with regard to pretherapeutic regional assessment and staging. In patients with lymphoma subtypes that show a variable FDG avidity (e.g., MALT lymphoma), DWI-MRI seems to be superior to both 18F-FDG-PET/CT and CE-CT.
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria marius.mayerhoefer@meduniwien.ac.at.
Marius E
ME
Mayerhoefer
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Georgios
G
Karanikas
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Kurt
K
Kletter
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Helmut
H
Prosch
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Barbara
B
Kiesewetter
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Cathrin
C
Skrabs
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Edit
E
Porpaczy
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Michael
M
Weber
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Katja
K
Pinker-Domenig
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Dominik
D
Berzaczy
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Martha
M
Hoffmann
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Christian
C
Sillaber
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Ulrich
U
Jaeger
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Leonhard
L
Müllauer
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Ingrid
I
Simonitsch-Klupp
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Werner
W
Dolak
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Alexander
A
Gaiger
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Philipp
P
Ubl
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Julius
J
Lukas
Authors' Affiliations: Departments of Biomedical Imaging and Image-guided Therapy, Internal Medicine I, Internal Medicine III, and Opthalmology and Optometry, and Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Markus
M
Raderer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008223:Lymphoma / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009367:Neoplasm Staging / Q000379:methods*; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18