Whole-body MRI for staging and interim response monitoring in paediatric and adolescent Hodgkin’s lymphoma: a comparison with multi-modality reference standard including 18F-FDG-PET-CT

Objectives To prospectively investigate concordance between whole-body MRI (WB-MRI) and a composite reference standard for initial staging and interim response evaluation in paediatric and adolescent Hodgkin’s lymphoma. Methods Fifty patients (32 male, age range 6–19 years) underwent WB-MRI and stan...
Ausführliche Beschreibung

Objectives To prospectively investigate concordance between whole-body MRI (WB-MRI) and a composite reference standard for initial staging and interim response evaluation in paediatric and adolescent Hodgkin’s lymphoma. Methods Fifty patients (32 male, age range 6–19 years) underwent WB-MRI and standard investigations, including 18F-FDG-PET-CT at diagnosis and following 2–3 chemotherapy cycles. Two radiologists in consensus interpreted WB-MRI using prespecified definitions of disease positivity. A third radiologist reviewed a subset of staging WB-MRIs (n = 38) separately to test for interobserver agreement. A multidisciplinary team derived a primary reference standard using all available imaging/clinical investigations. Subsequently, a second multidisciplinary panel rereviewed all imaging with long-term follow-up data to derive an enhanced reference standard. Interobserver agreement for WB-MRI reads was tested using kappa statistics. Concordance for correct classification of all disease sites, true positive rate (TPR), false positive rate (FPR) and kappa for staging/response agreement were calculated for WB-MRI. Results There was discordance for full stage in 74% (95% CI 61.9–83.9%) and 44% (32.0–56.6%) of patients against the primary and enhanced reference standards, respectively. Against the enhanced reference standard, the WB-MRI TPR, FPR and kappa were 91%, 1% and 0.93 (0.90–0.96) for nodal disease and 79%, < 1% and 0.86 (0.77–0.95) for extra-nodal disease. WB-MRI response classification was correct in 25/38 evaluable patients (66%), underestimating response in 26% (kappa 0.30, 95% CI 0.04–0.57). There was a good agreement for nodal (kappa 0.78, 95% CI 0.73–0.84) and extra-nodal staging (kappa 0.60, 95% CI 0.41–0.78) between WB-MRI reads Conclusions WB-MRI has reasonable accuracy for nodal and extra-nodal staging but is discordant with standard imaging in a substantial minority of patients, and tends to underestimate disease response. Key Points • This prospective single-centre study showed discordance for full patient staging of 44% between WB-MRI and a multi-modality reference standard in paediatric and adolescent Hodgkin’s lymphoma. • WB-MRI underestimates interim disease response in paediatric and adolescent Hodgkin’s lymphoma. • WB-MRI shows promise in paediatric and adolescent Hodgkin’s lymphoma but currently cannot replace conventional staging pathways including18F-FDG-PET-CT. Ausführliche Beschreibung

Autor*in:	Latifoltojar, Arash [verfasserIn] Punwani, Shonit Lopes, Andre Humphries, Paul D. Klusmann, Maria Menezes, Leon Jonathan Daw, Stephen Shankar, Ananth Neriman, Deena Fitzke, Heather Clifton-Hadley, Laura Smith, Paul Taylor, Stuart A.

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2018

Schlagwörter:	Whole-body scan Diffusion-weighted MRI Tumour staging Treatment Hodgkin lymphoma

Anmerkung:	© The Author(s) 2018

Übergeordnetes Werk:	Enthalten in: European radiology - Berlin : Springer, 1991, 29(2018), 1 vom: 15. Juni, Seite 202-212
Übergeordnetes Werk:	volume:29 ; year:2018 ; number:1 ; day:15 ; month:06 ; pages:202-212

Links:	Volltext

DOI / URN:	10.1007/s00330-018-5445-8

Katalog-ID:	SPR004048016