title: Whole-body MRI with diffusion-weighted imaging: a valuable alternative to contrast-enhanced CT for initial staging of aggressive lymphoma.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Radiology Division, Mauriziano-Umberto I Hospital, Torino, Italy. Electronic address: annalisa.balbomussetto@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Balbo-Mussetto
authors.affiliation: Radiology Division, Mauriziano-Umberto I Hospital, Torino, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Cirillo
authors.affiliation: Hematology and Cell Therapy Division, Mauriziano-Umberto I Hospital & University, Torino, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Bruna
authors.affiliation: Hematology and Cell Therapy Division, Mauriziano-Umberto I Hospital & University, Torino, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gueli
authors.affiliation: Radiology Division, Mauriziano-Umberto I Hospital, Torino, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Saviolo
authors.affiliation: Radiology Division, Mauriziano-Umberto I Hospital, Torino, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Petracchini
authors.affiliation: Radiology Division, Mauriziano-Umberto I Hospital, Torino, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Fornari
authors.affiliation: Radiology Division, Mauriziano-Umberto I Hospital, Torino, Italy.
authors.forename: C V
authors.initials: CV
authors.lastname: Lario
authors.affiliation: Hematology and Cell Therapy Division, Mauriziano-Umberto I Hospital & University, Torino, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Gottardi
authors.affiliation: Hematology and Cell Therapy Division, Mauriziano-Umberto I Hospital & University, Torino, Italy.
authors.forename: A
authors.initials: A
authors.lastname: De Crescenzo
authors.affiliation: Hematology and Cell Therapy Division, Mauriziano-Umberto I Hospital & University, Torino, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Tarella
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003287:Contrast Media; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007472:Iohexol / Q000031:analogs & derivatives; D008223:Lymphoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging / Q000379:methods*
chemical_list: D003287:Contrast Media; D019788:Fluorodeoxyglucose F18; D007472:Iohexol; C038192:iopromide