Whole-body MRI versus an [18F]FDG-PET/CT-based reference standard for early response assessment and restaging of paediatric Hodgkin’s lymphoma: a prospective multicentre study

• Published in: European radiology Vol. 31; no. 12; pp. 8925 - 8936
• Main Authors: Spijkers, Suzanne, Littooij, Annemieke S., Kwee, Thomas C., Tolboom, Nelleke, Beishuizen, Auke, Bruin, Marrie C. A., Enríquez, Goya, Sábado, Constantino, Miller, Elka, Granata, Claudio, de Lange, Charlotte, Verzegnassi, Federico, de Keizer, Bart, Nievelstein, Rutger A. J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2021; Springer Nature B.V
• Subjects: Adolescent; Agreements; Cancer and Oncology; Cancer och onkologi; Child; Children; Computed tomography; Diagnostic Radiology; Diffusion Magnetic Resonance Imaging; Evaluation; Fluorine isotopes; Fluorodeoxyglucose F18; Hodgkin disease; Hodgkin Disease - diagnostic imaging; Hodgkin Disease - pathology; Humans; Imaging; Internal Medicine; Interventional Radiology; Lymphoma; Magnetic Resonance Imaging; Mathematical analysis; Medicine; Medicine & Public Health; Neoplasm Staging; Neuroradiology; Nuclear medicine; observer variation; Paediatric; Pediatrics; Pediatrik; Positron emission; Positron emission tomography; Positron Emission Tomography Computed Tomography; Prospective Studies; Radiologi och bildbehandling; Radiology; Radiology, Nuclear Medicine and Medical Imaging; Radiopharmaceuticals; Reference Standards; Tomography; Ultrasound; Whole Body Imaging; Positron emission tomography computed tomography, observer variation; Hodgkin disease; Diffusion magnetic resonance imaging; Whole-body imaging; Child
• ISSN: 0938-7994; 1432-1084; 1432-1084
• DOI: 10.1007/s00330-021-08026-1

Objectives To compare WB-MRI with an [ 18 F]FDG-PET/CT-based reference for early response assessment and restaging in children with Hodgkin’s lymphoma (HL). Methods Fifty-one children (ages 10–17) with HL were included in this prospective, multicentre study. All participants underwent WB-MRI and [ 18 F]FDG-PET/CT at early response assessment. Thirteen of the 51 patients also underwent both WB-MRI and [ 18 F]FDG-PET/CT at restaging. Two radiologists independently evaluated all WB-MR images in two separate readings: without and with DWI. The [ 18 F]FDG-PET/CT examinations were evaluated by a nuclear medicine physician. An expert panel assessed all discrepancies between WB-MRI and [ 18 F]FDG-PET/CT to derive the [ 18 F]FDG-PET/CT-based reference standard. Inter-observer agreement for WB-MRI was calculated using kappa statistics. Concordance, PPV, NPV, sensitivity and specificity for a correct assessment of the response between WB-MRI and the reference standard were calculated for both nodal and extra-nodal disease presence and total response evaluation. Results Inter-observer agreement of WB-MRI including DWI between both readers was moderate ( κ 0.46–0.60). For early response assessment, WB-MRI DWI agreed with the reference standard in 33/51 patients (65%, 95% CI 51–77%) versus 15/51 (29%, 95% CI 19–43%) for WB-MRI without DWI. For restaging, WB-MRI including DWI agreed with the reference standard in 9/13 patients (69%, 95% CI 42–87%) versus 5/13 patients (38%, 95% CI 18–64%) for WB-MRI without DWI. Conclusions The addition of DWI to the WB-MRI protocol in early response assessment and restaging of paediatric HL improved agreement with the [ 18 F]FDG-PET/CT-based reference standard. However, WB-MRI remained discordant in 30% of the patients compared to standard imaging for assessing residual disease presence. Key Points • Inter-observer agreement of WB-MRI including DWI between both readers was moderate for (early) response assessment of paediatric Hodgkin’s lymphoma. • The addition of DWI to the WB-MRI protocol in early response assessment and restaging of paediatric Hodgkin’s lymphoma improved agreement with the [18F]FDG-PET/CT-based reference standard. • WB-MRI including DWI agreed with the reference standard in respectively 65% and 69% of the patients for early response assessment and restaging.