Whole-body diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient mapping for staging patients with diffuse large B-cell lymphoma

ObjectiveTo design a whole-body MR protocol using exclusively diffusion-weighted imaging (DWI) with respiratory gating and to assess its value for lesion detection and staging in patients with diffuse large B-cell lymphoma (DLBCL), with integrated FDG PET/CT as the reference standard.MethodsFifteen patients underwent both whole-body DWI (b = 50, 400, 800 s/mm2) and PET/CT for pretreatment staging. Lymph node and organ involvement were evaluated by qualitative and quantitative image analysis, including measurement of the mean apparent diffusion coefficient (ADC).ResultsA total of 296 lymph node regions in the 15 patients were analysed. Based on International Working Group size criteria alone, DWI findings matched PET/CT findings in 277 regions (94%) (kappa score = 0.85, P < 0.0001), yielding sensitivity and specificity for DWI lymph node involvement detection of 90% and 94%. Combining visual ADC analysis with size measurement increased DWI specificity to 100% with 81% sensitivity. For organ involvement, the two techniques agreed in all 20 recorded organs (100%). All involved organ lesions showed restricted diffusion. Ann Arbor stages agreed in 14 (93%) of the 15 patients.ConclusionWhole-body DWI with ADC analysis can potentially be used for lesion detection and staging in patients with DLBCL.

[1]  M. Tomas,et al.  18F-FDG PET versus CT for evaluating the spleen during initial staging of lymphoma. , 2003, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[2]  S. Takashima,et al.  Head and neck lesions: characterization with diffusion-weighted echo-planar MR imaging. , 2001, Radiology.

[3]  K. E. Hunt,et al.  Diffuse large B-cell lymphoma. , 2008, Archives of pathology & laboratory medicine.

[4]  B. Falini,et al.  Diffuse large B‐cell lymphoma: one or more entities? Present controversies and possible tools for its subclassification , 2002, Histopathology.

[5]  Sigrid Stroobants,et al.  Revised response criteria for malignant lymphoma. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[6]  Modality.  APPLICATION OF WHOLE BODY DIFFUSION WEIGHTED MR IMAGING FOR DIAGNOSIS AND STAGING OF MALIGNANT LYMPHOMA , 2008 .

[7]  L. Quekel,et al.  CT and 18F-FDG PET for noninvasive detection of splenic involvement in patients with malignant lymphoma. , 2009, AJR. American journal of roentgenology.

[8]  J. Armitage,et al.  Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. NCI Sponsored International Working Group. , 1999, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[9]  P. Choyke,et al.  Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. , 2009, Neoplasia.

[10]  Wilson Fong.  Handbook of MRI Pulse Sequences , 2005 .

[11]  I. Narabayashi,et al.  2-[Fluorine-18]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography versus whole-body diffusion-weighted MRI for detection of malignant lesions: initial experience , 2007, Annals of nuclear medicine.

[12]  E. Merkle,et al.  Extranodal malignant lymphoma: detection with FDG PET versus CT. , 1998, Radiology.

[13]  Klemens Scheidhauer,et al.  Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  A. Soricelli,et al.  Contrast-enhanced harmonic compound US of the spleen to increase staging accuracy in patients with Hodgkin lymphoma: a prospective study. , 2009, Radiology.

[15]  T. Takahara,et al.  Whole-Body MRI, Including Diffusion-Weighted Imaging, for the Initial Staging of Malignant Lymphoma: Comparison to Computed Tomography , 2009, Investigative radiology.

[16]  J Kotzerke,et al.  Lymphoma: role of whole-body 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) PET in nodal staging. , 1997, Radiology.

[17]  T. Takahara,et al.  Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high resolution 3D display. , 2004, Radiation medicine.

[18]  Pascal Spincemaille,et al.  Effective motion‐sensitizing magnetization preparation for black blood magnetic resonance imaging of the heart , 2008, Journal of magnetic resonance imaging : JMRI.

[19]  Thomas F Hany,et al.  Non-Hodgkin lymphoma and Hodgkin disease: coregistered FDG PET and CT at staging and restaging--do we need contrast-enhanced CT? , 2004, Radiology.

[20]  Dow-Mu Koh,et al.  Practical aspects of assessing tumors using clinical diffusion-weighted imaging in the body. , 2007, Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine.

[21]  Peter R. Luijten,et al.  Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS): features and potential applications in oncology , 2008, European Radiology.

[22]  S. Shiraishi,et al.  Diffusion-Weighted Magnetic Resonance Imaging for Diagnosing Malignant Pulmonary Nodules/Masses: Comparison with Positron Emission Tomography , 2008, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[23]  S. Ng,et al.  Primary Cerebral Lymphoma and Glioblastoma Multiforme: Differences in Diffusion Characteristics Evaluated with Diffusion Tensor Imaging , 2008, American Journal of Neuroradiology.

[24]  A. Luciani,et al.  Liver Cirrhosis : Intravoxel Incoherent Motion MR Imaging — Pilot Study 1 , 2008 .

[25]  V. Wedeen,et al.  Reduction of eddy‐current‐induced distortion in diffusion MRI using a twice‐refocused spin echo , 2003, Magnetic resonance in medicine.

[26]  D. Collins,et al.  Diffusion-weighted MRI in the body: applications and challenges in oncology. , 2007, AJR. American journal of roentgenology.

[27]  Y. Erdi,et al.  Intensity of 18fluorodeoxyglucose uptake in positron emission tomography distinguishes between indolent and aggressive non-Hodgkin's lymphoma. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[28]  A. Rahmouni,et al.  Prognostic Value of Interim 18F-FDG PET in Patients with Diffuse Large B-Cell Lymphoma: SUV-Based Assessment at 4 Cycles of Chemotherapy , 2009, Journal of Nuclear Medicine.

[29]  A. Stecco,et al.  Whole-body diffusion-weighted magnetic resonance imaging in the staging of oncological patients: comparison with positron emission tomography computed tomography (PET-CT) in a pilot study , 2009, La radiologia medica.

[30]  M. Kanematsu,et al.  Head and neck squamous cell carcinoma: usefulness of diffusion-weighted MR imaging in the prediction of a neoadjuvant therapeutic effect , 2008, European Radiology.

[31]  Emmanuel Itti,et al.  Early 18F-FDG PET for Prediction of Prognosis in Patients with Diffuse Large B-Cell Lymphoma: SUV-Based Assessment Versus Visual Analysis , 2007, Journal of Nuclear Medicine.

[32]  D. Yeung,et al.  Malignant cervical lymphadenopathy: diagnostic accuracy of diffusion-weighted MR imaging. , 2007, Radiology.

[33]  C. Claussen,et al.  Tumor Detection by Diffusion-Weighted MRI and ADC-Mapping—Initial Clinical Experiences in Comparison to PET-CT , 2007, Investigative radiology.

[34]  Thomas C Kwee,et al.  Imaging in staging of malignant lymphoma: a systematic review. , 2008, Blood.

[35]  Frederik De Keyzer,et al.  Extracranial applications of diffusion-weighted magnetic resonance imaging , 2007, European Radiology.

[36]  Peter R Luijten,et al.  Comparison and reproducibility of ADC measurements in breathhold, respiratory triggered, and free‐breathing diffusion‐weighted MR imaging of the liver , 2008, Journal of magnetic resonance imaging : JMRI.

[37]  T. Yen,et al.  Correlation of apparent diffusion coefficients measured by 3T diffusion-weighted MRI and SUV from FDG PET/CT in primary cervical cancer , 2008, European Journal of Nuclear Medicine and Molecular Imaging.

[38]  K. Chida,et al.  Higher sensitivity and specificity for diffusion-weighted imaging of malignant lung lesions without apparent diffusion coefficient quantification. , 2009, Radiology.

[39]  M. Sumi,et al.  Diagnostic ability of apparent diffusion coefficients for lymphomas and carcinomas in the pharynx , 2007, European Radiology.

[40]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[41]  Sandra Nuyts,et al.  Head and neck squamous cell carcinoma: value of diffusion-weighted MR imaging for nodal staging. , 2009, Radiology.

[42]  Martin Hutchings,et al.  FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma. , 2006, Blood.

[43]  A. Luciani,et al.  Quantitative CT analysis for assessing response in lymphoma (Cheson’s criteria) , 2005, Cancer imaging : the official publication of the International Cancer Imaging Society.

[44]  H. Honda,et al.  Usefulness of the calculated apparent diffusion coefficient value in the differential diagnosis of retroperitoneal masses , 2004, Journal of magnetic resonance imaging : JMRI.