Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jan 28, 2025; 17(1): 99207
Published online Jan 28, 2025. doi: 10.4329/wjr.v17.i1.99207
Whole-body magnetic resonance imaging provides accurate staging of diffuse large B-cell lymphoma, but is less preferred by patients
Lukas Lambert, Monika Wagnerova, Prokop Vodicka, Katerina Benesova, David Zogala, Marek Trneny, Andrea Burgetova
Lukas Lambert, Department of Imaging Methods, Motol University Hospital and Second Faculty of Medicine, Charles University, Prague 15006, Czech Republic
Monika Wagnerova, Andrea Burgetova, Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 12808, Czech Republic
Prokop Vodicka, Katerina Benesova, Marek Trneny, First Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 12808, Czech Republic
David Zogala, Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague 12808, Czech Republic
Author contributions: Lambert L, Trneny M, Zogala D and Burgetova A contributed to conceptualization; Lambert L and Trneny M contributed to methodology; Lambert L, Wagnerova M, Vodicka P, Benesova K, Zogala D, Trneny M and Burgetova A contributed to data collection, writing review and editing; Lambert L and Vodicka P contributed to data analysis, writing original draft; Lambert L contributed to visualization.
Supported by the Czech Ministry of Health, General University Hospital in Prague, No. VFN00064165.
Institutional review board statement: This single-center prospective study was performed in accordance with the Declaration of Helsinki (rev. 2013) and approved by the Ethics Committee of the General University Hospital in Prague.
Clinical trial registration statement: Observational study (not registered) as a sub-study of the Czech Lymphoma Study Group (No. NCT03199066).
Informed consent statement: All participants signed an informed consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: All data are available upon reasonable request to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lukas Lambert, PhD, Professor, Department of Imaging Methods, Motol University Hospital and Second Faculty of Medicine, Charles University, V Úvalu 84, 15006 Praha 5, Prague 15006, Czech Republic. lukas.lambert@vfn.cz
Received: July 16, 2024
Revised: December 8, 2024
Accepted: December 25, 2024
Published online: January 28, 2025
Processing time: 188 Days and 10.7 Hours
Abstract
BACKGROUND

Whole-body magnetic resonance imaging (wbMRI) allows general assessment of systemic cancers including lymphomas without radiation burden.

AIM

To evaluate the diagnostic performance of wbMRI in the staging of diffuse large B-cell lymphoma (DLBCL), determine the value of individual MRI sequences, and assess patients’ concerns with wbMRI.

METHODS

In this single-center prospective study, adult patients newly diagnosed with systemic DLBCL underwent wbMRI on a 3T scanner [diffusion weighted images with background suppression (DWIBS), T2, short tau inversion recovery (STIR), contrast-enhanced T1] and fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) (reference standard). The involvement of 12 nodal regions and extranodal sites was evaluated on wbMRI and PET/CT. The utility of wbMRI sequences was rated on a five-point scale (0 = not useful, 4 = very useful). Patients received a questionnaire regarding wbMRI.

RESULTS

Of 60 eligible patients, 14 (23%) were enrolled and completed the study. The sensitivity of wbMRI in the nodal involvement (182 nodal sites) was 0.84, with 0.99 specificity, positive predictive value of 0.96, negative predictive value of 0.97, and 0.97 accuracy. PET/CT and wbMRI were concordant both in extranodal involvement (13 instances) and staging (κ = 1.0). The mean scores of the utility of MRI sequences were 3.71 ± 0.73 for DWIBS, 2.64 ± 0.84 for T1, 2.14 ± 0.77 for STIR, and 1.29 ± 0.73 for T2 (P < 0.0001). Patients were mostly concerned about the enclosed environment and duration of the MRI examination (27% of patients).

CONCLUSION

The wbMRI exhibited excellent sensitivity and specificity in staging DLBCL. DWIBS and contrast-enhanced T1 were rated as the most useful sequences. Patients were less willing to undergo wbMRI as a second examination parallel to PET/CT, especially owing to the long duration and the enclosed environment.

Keywords: Diffuse large B-cell lymphoma; Magnetic resonance imaging; Positron emission tomography/computed tomography; Staging; Preference

Core Tip: Although the agreement in nodal and extranodal involvement by diffuse large-cell B lymphoma is excellent, patients are less willing to undergo whole-body magnetic resonance imaging (wbMRI) as a second examination parallel to positron emission tomography/computed tomography. wbMRI is less well accepted, and patients are concerned about the enclosed environment and duration of the MRI examination. The measurements of lymph node dimensions and quantification of restricted diffusion are not better guides of nodal involvement than visual assessment by an experienced radiologist. Diffusion weighted images with background suppression and contrast-enhanced T1 were the most useful sequences in wbMRI, allowing the imaging protocol to be shortened.