Whole-body diffusion-weighted imaging: the added value to whole-body MRI at initial diagnosis of lymphoma

Jing Gu, Tao Chan, Jingbo Zhang, Anskar Y H Leung, Yok-Lam Kwong, Pek-Lan Khong
AJR. American Journal of Roentgenology 2011, 197 (3): W384-91

OBJECTIVE: The objective of our study was to evaluate the diagnostic performance of conventional whole-body MRI without and with diffusion-weighted imaging (DWI) in the detection of known (18)F-FDG-avid lymphomas. The conventional whole-body MRI protocol consisted of a T2-weighted sequence and a T2-weighted spectral attenuated inversion recovery (SPAIR) sequence with frequency-selective fat suppression. The second protocol used the same sequences as the first protocol but also included DWI.

SUBJECTS AND METHODS: Seventeen patients with pathologically confirmed, newly diagnosed, untreated lymphoma were recruited. T2-weighted and T2-weighted SPAIR images were evaluated first, separate from the DW images, and then were evaluated with the DW images. We used (18)F-FDG PET/CT as the standard of reference. True-positive, false-positive, and false-negative values were evaluated on a per-lesion basis. Tumor staging based on T2-weighted and T2-weighted SPAIR imaging without DWI and then with DWI was compared using the Ann Arbor staging system.

RESULTS: True-positive lesions were increased from 89% to 97%, false-positive lesions were increased from 3% to 6%, and false-negative lesions were decreased from 11% to 3% by the addition of DWI. Diagnostic sensitivity was significantly increased (p = 0.002) by adding DWI. Lesions detected on DWI but not on T2-weighted and T2-weighted SPAIR imaging were located in renal (n = 1), paraaortic (n = 6), and pelvic (n = 3) lymph nodes. On DWI, 47% of the lesions (n = 55) were more conspicuous than on T2-weighted and T2-weighted SPAIR imaging; most of these lesions (58%, n = 32) were from lymph nodes in the pelvic or abdominal regions and bone marrow. No difference was found between T2-weighted and T2-weighted SPAIR imaging without DWI and T2-weighted and T2-weighted SPAIR imaging with DWI in lymphoma staging, being consistent with PET/CT in 88% of the patients (n = 15).

CONCLUSION: The addition of DWI to conventional whole-body MRI sequences enhanced lesion conspicuity and improved diagnostic accuracy for lymphomas. With technical optimization, whole-body MRI with DWI, as a nonionizing imaging modality, may potentially be useful as an alternative method to PET/CT in the management of malignant lymphoma.

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