PET/MRI for the Evaluation of Patients with Lymphoma: Initial Observations

Overview

Journal AJR Am J Roentgenol

Specialties Oncology
Radiology

Date 2015 Mar 21

PMID 25794075

Citations 45

Authors

Laura Heacock

Joseph Weissbrot

Roy Raad

Naomi Campbell

Kent P Friedman

Fabio Ponzo

Hersh Chandarana

Affiliations

Soon will be listed here.

Abstract

Objective: The objective of our study was to assess the role of recently introduced hybrid PET/MRI in the evaluation of lymphoma patients using PET/CT as a reference standard.

Subjects And Methods: In this prospective study 28 consecutive lymphoma patients (18 men, 10 women; mean age, 53.6 years) undergoing clinically indicated PET/ CT were subsequently imaged with PET/MRI using residual FDG activity from the PET/ CT study. Blinded readers evaluated PET/CT (reference standard), PET/MRI, and diffusion-weighted imaging (DWI) studies separately; for each study, they assessed nodal and extranodal involvement. Each FDG-avid nodal station was marked and compared on DWI, PET/MRI, and PET/CT. Modified Ann Arbor staging was performed and compared between PET/MRI and PET/CT. The maximum standardized uptake value (SUVmax) on PET/MRI for FDG-avid nodal lesions was compared with the SUVmax on PET/CT. The apparent diffusion coefficient (ADC) for FDG-avid nodal lesions was compared to SUVmax on PET/MRI.

Results: Fifty-one FDG-avid nodal groups were identified on PET/CT in 13 patients. PET/MRI identified 51 of these nodal groups with a sensitivity of 100%. DWI identified 32 nodal groups for a sensitivity of 62.7%. PET/MRI staging and PET/CT staging were concordant in 96.4% of patients. For the one patient with discordant staging results, disease was correctly upstaged to stage IV on the basis of the PET/MRI finding of bone marrow involvement, which was missed on PET/CT. DWI staging was concordant with PET/CT staging in 64.3% of the patients. The increased staging accuracy of PET/MRI relative to DWI was significant (p=0.004). SUVmax measured on PET/MRI and PET/CT showed excellent statistically significant correlation (r=0.98, p<0.001). There was a poor negative correlation between ADC and SUVmax (r=-0.036, p=0.847).

Conclusion: PET/MRI can be used to assess disease burden in lymphoma with sensitivity similar to PET/CT and can be a viable alternative for lymphoma staging and follow-up.

Citing Articles

Mapping the landscape and research trend of imaging diagnosis in lymphoma: a bibliometric analysis from 1976 to 2024.

Ma Y Front Med (Lausanne). 2025; 12:1516817.

PMID: 39944492 PMC: 11813927. DOI: 10.3389/fmed.2025.1516817.

Prediction of therapy response of breast cancer patients with machine learning based on clinical data and imaging data derived from breast [F]FDG-PET/MRI.

Jannusch K, Dietzel F, Bruckmann N, Morawitz J, Boschheidgen M, Minko P Eur J Nucl Med Mol Imaging. 2023; 51(5):1451-1461.

PMID: 38133687 PMC: 10957677. DOI: 10.1007/s00259-023-06513-9.

Diffuse large B-cell lymphoma presenting as sternal mass in a patient with ankylosing spondylitis: a case report study.

Borhani A, Daskareh M, Gilanchi S, Vakilpour A, Poursharif M, Vojdanian M Ann Med Surg (Lond). 2023; 85(5):2068-2072.

PMID: 37229029 PMC: 10205270. DOI: 10.1097/MS9.0000000000000531.

Whole body MRI with Diffusion Weighted Imaging versus 18F-fluorodeoxyglucose-PET/CT in the staging of lymphomas.

Maccioni F, Alfieri G, Assanto G, Mattone M, Gentiloni Silveri G, Viola F Radiol Med. 2023; 128(5):556-564.

PMID: 37145214 PMC: 10182138. DOI: 10.1007/s11547-023-01622-9.

Towards a fast PET/MRI protocol for breast cancer imaging: maintaining diagnostic confidence while reducing PET and MRI acquisition times.

Jannusch K, Lindemann M, Bruckmann N, Morawitz J, Dietzel F, Pomykala K Eur Radiol. 2023; 33(9):6179-6188.

PMID: 37045980 PMC: 10415438. DOI: 10.1007/s00330-023-09580-6.

References

Rakheja R, Chandarana H, DeMello L, Jackson K, Geppert C, Faul D . Correlation between standardized uptake value and apparent diffusion coefficient of neoplastic lesions evaluated with whole-body simultaneous hybrid PET/MRI. AJR Am J Roentgenol. 2013; 201(5):1115-9. DOI: 10.2214/AJR.13.11304. View

Wu X, Pertovaara H, Korkola P, Dastidar P, Jarvenpaa R, Eskola H . Correlations between functional imaging markers derived from PET/CT and diffusion-weighted MRI in diffuse large B-cell lymphoma and follicular lymphoma. PLoS One. 2014; 9(1):e84999. PMC: 3893149. DOI: 10.1371/journal.pone.0084999. View

Heusch P, Buchbender C, Kohler J, Nensa F, Gauler T, Gomez B . Thoracic staging in lung cancer: prospective comparison of 18F-FDG PET/MR imaging and 18F-FDG PET/CT. J Nucl Med. 2014; 55(3):373-8. DOI: 10.2967/jnumed.113.129825. View

Kwee T, Vermoolen M, Akkerman E, Kersten M, Fijnheer R, Ludwig I . Whole-body MRI, including diffusion-weighted imaging, for staging lymphoma: comparison with CT in a prospective multicenter study. J Magn Reson Imaging. 2013; 40(1):26-36. DOI: 10.1002/jmri.24356. View

Hagtvedt T, Seierstad T, Lund K, Londalen A, Bogsrud T, Smith H . Diffusion-weighted MRI compared to FDG PET/CT for assessment of early treatment response in lymphoma. Acta Radiol. 2014; 56(2):152-8. DOI: 10.1177/0284185114526087. View

Querellou S, Valette F, Bodet-Milin C, Oudoux A, Carlier T, Harousseau J . FDG-PET/CT predicts outcome in patients with aggressive non-Hodgkin's lymphoma and Hodgkin's disease. Ann Hematol. 2006; 85(11):759-67. DOI: 10.1007/s00277-006-0151-z. View

Juweid M, Stroobants S, Hoekstra O, Mottaghy F, Dietlein M, Guermazi A . Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol. 2007; 25(5):571-8. DOI: 10.1200/JCO.2006.08.2305. View

Terasawa T, Nihashi T, Hotta T, Nagai H . 18F-FDG PET for posttherapy assessment of Hodgkin's disease and aggressive Non-Hodgkin's lymphoma: a systematic review. J Nucl Med. 2007; 49(1):13-21. DOI: 10.2967/jnumed.107.039867. View

Ho K, Lin G, Wang J, Lai C, Chang C, Yen T . Correlation of apparent diffusion coefficients measured by 3T diffusion-weighted MRI and SUV from FDG PET/CT in primary cervical cancer. Eur J Nucl Med Mol Imaging. 2008; 36(2):200-8. DOI: 10.1007/s00259-008-0936-5. View

10.

Hutchings M, Barrington S . PET/CT for therapy response assessment in lymphoma. J Nucl Med. 2009; 50 Suppl 1:21S-30S. DOI: 10.2967/jnumed.108.057190. View

11.

Cronin C, Swords R, Truong M, Viswanathan C, Rohren E, Giles F . Clinical utility of PET/CT in lymphoma. AJR Am J Roentgenol. 2009; 194(1):W91-W103. DOI: 10.2214/AJR.09.2637. View

12.

Lin C, Luciani A, Itti E, El-Gnaoui T, Vignaud A, Beaussart P . Whole-body diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient mapping for staging patients with diffuse large B-cell lymphoma. Eur Radiol. 2010; 20(8):2027-38. DOI: 10.1007/s00330-010-1758-y. View

13.

Quarles van Ufford H, Kwee T, Beek F, van Leeuwen M, Takahara T, Fijnheer R . Newly diagnosed lymphoma: initial results with whole-body T1-weighted, STIR, and diffusion-weighted MRI compared with 18F-FDG PET/CT. AJR Am J Roentgenol. 2011; 196(3):662-9. DOI: 10.2214/AJR.10.4743. View

14.

Cashen A, Dehdashti F, Luo J, Homb A, Siegel B, Bartlett N . 18F-FDG PET/CT for early response assessment in diffuse large B-cell lymphoma: poor predictive value of international harmonization project interpretation. J Nucl Med. 2011; 52(3):386-92. PMC: 4019941. DOI: 10.2967/jnumed.110.082586. View

15.

Abdulqadhr G, Molin D, Astrom G, Suurkula M, Johansson L, Hagberg H . Whole-body diffusion-weighted imaging compared with FDG-PET/CT in staging of lymphoma patients. Acta Radiol. 2011; 52(2):173-80. DOI: 10.1258/ar.2010.100246. View

16.

Wu X, Korkola P, Pertovaara H, Eskola H, Jarvenpaa R, Kellokumpu-Lehtinen P . No correlation between glucose metabolism and apparent diffusion coefficient in diffuse large B-cell lymphoma: a PET/CT and DW-MRI study. Eur J Radiol. 2011; 79(2):e117-21. DOI: 10.1016/j.ejrad.2011.04.062. View

17.

Wu X, Kellokumpu-Lehtinen P, Pertovaara H, Korkola P, Soimakallio S, Eskola H . Diffusion-weighted MRI in early chemotherapy response evaluation of patients with diffuse large B-cell lymphoma--a pilot study: comparison with 2-deoxy-2-fluoro- D-glucose-positron emission tomography/computed tomography. NMR Biomed. 2011; 24(10):1181-90. DOI: 10.1002/nbm.1689. View

18.

Drzezga A, Souvatzoglou M, Eiber M, Beer A, Furst S, Martinez-Moller A . First clinical experience with integrated whole-body PET/MR: comparison to PET/CT in patients with oncologic diagnoses. J Nucl Med. 2012; 53(6):845-55. DOI: 10.2967/jnumed.111.098608. View

19.

Regier M, Derlin T, Schwarz D, Laqmani A, Henes F, Groth M . Diffusion weighted MRI and 18F-FDG PET/CT in non-small cell lung cancer (NSCLC): does the apparent diffusion coefficient (ADC) correlate with tracer uptake (SUV)?. Eur J Radiol. 2011; 81(10):2913-8. DOI: 10.1016/j.ejrad.2011.11.050. View

20.

Wiesmuller M, Quick H, Navalpakkam B, Lell M, Uder M, Ritt P . Comparison of lesion detection and quantitation of tracer uptake between PET from a simultaneously acquiring whole-body PET/MR hybrid scanner and PET from PET/CT. Eur J Nucl Med Mol Imaging. 2012; 40(1):12-21. DOI: 10.1007/s00259-012-2249-y. View