Advertisement

Pediatric Radiology

, Volume 43, Issue 8, pp 941–949 | Cite as

Dynamic contrast-enhanced MRI improves accuracy for detecting focal splenic involvement in children and adolescents with Hodgkin disease

  • Shonit PunwaniEmail author
  • King Kenneth Cheung
  • Nicholas Skipper
  • Nichola Bell
  • Alan Bainbridge
  • Stuart A. Taylor
  • Ashley M. Groves
  • Sharon F. Hain
  • Simona Ben-Haim
  • Ananth Shankar
  • Stephen Daw
  • Steve Halligan
  • Paul D. Humphries
Original Article

Abstract

Background

Accurate assessment of splenic disease is important for staging Hodgkin lymphoma.

Objective

The purpose of this study was to assess T2-weighted imaging with and without dynamic contrast-enhanced (DCE) MRI for evaluation of splenic Hodgkin disease.

Materials and methods

Thirty-one children with Hodgkin lymphoma underwent whole-body T2-weighted MRI with supplementary DCE splenic imaging, and whole-body PET-CT before and following chemotherapy. Two experienced nuclear medicine physicians derived a PET-CT reference standard for splenic disease, augmented by follow-up imaging. Unaware of the PET-CT, two experienced radiologists independently evaluated MRI exercising a locked sequential read paradigm (T2-weighted then DCE review) and recorded the presence/absence of splenic disease at each stage. Performance of each radiologist was determined prior to and following review of DCE-MRI. Incorrect MRI findings were ascribed to reader (lesion present on MRI but missed by reader) or technical (lesion not present on MRI) error.

Results

Seven children had splenic disease. Sensitivity/specificity of both radiologists for the detection of splenic involvement using T2-weighted images alone was 57%/100% and increased to 100%/100% with DCE-MRI. There were three instances of technical error on T2-weighted imaging; all lesions were visible on DCE-MRI.

Conclusions

T2-weighted imaging when complemented by DCE-MRI imaging may improve evaluation of Hodgkin disease splenic involvement.

Keywords

Magnetic resonance imaging Spleen Hodgkin disease Pediatrics Positron-emission tomography Computed tomography 

Notes

Acknowledgments

This work was undertaken at the Comprehensive Biomedical Centre, University College Hospital London, which received a proportion of the funding from the National Institute for Health Research. The views expressed in this publication are those of the authors and not necessarily those of the UK Department of Health. The authors are grateful to the Royal College of Radiologists and the Radiological Research Trust for grants in support of this work.

References

  1. 1.
    Chavhan GB, Babyn PS (2011) Whole-body MR imaging in children: principles, technique, current applications, and future directions. Radiographics 31:1757–1772PubMedCrossRefGoogle Scholar
  2. 2.
    Rueffer U, Sieber M, Stemberg M et al (2003) Spleen involvement in Hodgkin’s lymphoma: assessment and risk profile. Ann Hematol 82:390–396PubMedCrossRefGoogle Scholar
  3. 3.
    Pendlebury SC, Boyages S, Koutts J et al (1992) Thymic hyperplasia associated with Hodgkin disease and thyrotoxicosis. Cancer 70:1985–1987PubMedCrossRefGoogle Scholar
  4. 4.
    Rathore B, Kadin ME (2010) Hodgkin’s lymphoma therapy: past, present, and future. Expert Opin Pharmacother 11:2891–2906PubMedCrossRefGoogle Scholar
  5. 5.
    Abdulqadhr G, Molin D, Astrom G et al (2011) Whole-body diffusion-weighted imaging compared with FDG-PET/CT in staging of lymphoma patients. Acta Radiol 52:173–180PubMedCrossRefGoogle Scholar
  6. 6.
    Kwee TC, van Ufford HM, Beek FJ et al (2009) Whole-body MRI, including diffusion-weighted imaging, for the initial staging of malignant lymphoma: comparison to computed tomography. Invest Radiol 44:683–690PubMedCrossRefGoogle Scholar
  7. 7.
    van Ufford HM, Kwee TC, Beek FJ et al (2011) 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 196:662–669PubMedCrossRefGoogle Scholar
  8. 8.
    Punwani S, Taylor SA, Bainbridge A et al (2010) Pediatric and adolescent lymphoma: comparison of whole-body STIR half-Fourier RARE MR imaging with an enhanced PET/CT reference for initial staging. Radiology 255:182–190PubMedCrossRefGoogle Scholar
  9. 9.
    Mauch PM (1994) Controversies in the management of early stage Hodgkin’s disease. Blood 83:318–329PubMedGoogle Scholar
  10. 10.
    Bhatia K, Sahdev A, Reznek RH (2007) Lymphoma of the spleen. Semin Ultrasound CT MR 28:12–20PubMedCrossRefGoogle Scholar
  11. 11.
    Huang B, Law MW, Khong PL (2009) Whole-body PET/CT scanning: estimation of radiation dose and cancer risk. Radiology 251:166–174PubMedCrossRefGoogle Scholar
  12. 12.
    Brenner D, Elliston C, Hall E et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296PubMedCrossRefGoogle Scholar
  13. 13.
    Kleinerman RA (2006) Cancer risks following diagnostic and therapeutic radiation exposure in children. Pediatr Radiol 36:121–125PubMedCrossRefGoogle Scholar
  14. 14.
    Kleis M, Daldrup-Link H, Matthay K et al (2009) Diagnostic value of PET/CT for the staging and restaging of pediatric tumors. Eur J Nucl Med Mol Imaging 36:23–36PubMedCrossRefGoogle Scholar
  15. 15.
    Mirowitz SA, Brown JJ, Lee JK et al (1991) Dynamic gadolinium-enhanced MR imaging of the spleen: normal enhancement patterns and evaluation of splenic lesions. Radiology 179:681–686PubMedGoogle Scholar
  16. 16.
    Landis JR, Koch GG (1977) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 33:363–374PubMedCrossRefGoogle Scholar
  17. 17.
    Bossuyt PM, Reitsma JB, Bruns DE et al (2003) Toward complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Acad Radiol 10:664–669PubMedCrossRefGoogle Scholar
  18. 18.
    de Jong PA, van Ufford HM, Baarsiag HJ et al (2009) CT and 18F-FDG PET for noninvasive detection of splenic involvement in patients with malignant lymphoma. AJR Am J Roentgenol 192:745–753PubMedCrossRefGoogle Scholar
  19. 19.
    Hoane BR, Shields AF, Porter BA et al (1994) Comparison of initial lymphoma staging using computed tomography (CT) and magnetic resonance (MR) imaging. Am J Hematol 47:100–105PubMedCrossRefGoogle Scholar
  20. 20.
    Kellenberger CJ, Epelman M, Miller SF et al (2004) Fast STIR whole-body MR imaging in children. Radiographics 24:1317–1330PubMedCrossRefGoogle Scholar
  21. 21.
    Runge VM, Williams NM (1998) Dynamic contrast-enhanced magnetic resonance imaging in a model of splenic metastasis. Invest Radiol 33:45–50PubMedCrossRefGoogle Scholar
  22. 22.
    Chang WC, Liou CH, Kao HW et al (2007) Solitary lymphangioma of the spleen: dynamic MR findings with pathological correlation. Br J Radiol 80:e4–e6PubMedCrossRefGoogle Scholar
  23. 23.
    Elsayes KM, Narra VR, Mukundan G et al (2005) MR imaging of the spleen: spectrum of abnormalities. Radiographics 25:967–982PubMedCrossRefGoogle Scholar
  24. 24.
    Hernandez-Maraver D, Hernandez-Navarro F, Gomez-Leon N et al (2006) Positron emission tomography/computed tomography: diagnostic accuracy in lymphoma. Br J Haematol 135:293–302PubMedCrossRefGoogle Scholar
  25. 25.
    Rini JN, Leonidas JC, Tomas MB et al (2003) 18F-FDG PET versus CT for evaluating the spleen during initial staging of lymphoma. J Nucl Med 44:1072–1074PubMedGoogle Scholar
  26. 26.
    Rini JN, Manalili EY, Hoffman MA et al (2002) F-18 FDG versus Ga-67 for detecting splenic involvement in Hodgkin’s disease. Clin Nucl Med 27:572–577PubMedCrossRefGoogle Scholar
  27. 27.
    Lister TA, Crowther D, Sutcliffe SB et al (1989) Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin’s disease: Cotswolds meeting. J Clin Oncol 7:1630–1636PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Shonit Punwani
    • 1
    • 2
    Email author
  • King Kenneth Cheung
    • 1
  • Nicholas Skipper
    • 1
  • Nichola Bell
    • 2
  • Alan Bainbridge
    • 4
  • Stuart A. Taylor
    • 1
    • 2
  • Ashley M. Groves
    • 5
  • Sharon F. Hain
    • 5
  • Simona Ben-Haim
    • 5
  • Ananth Shankar
    • 3
  • Stephen Daw
    • 3
  • Steve Halligan
    • 1
    • 2
  • Paul D. Humphries
    • 2
  1. 1.Centre for Medical ImagingUniversity College LondonLondonUK
  2. 2.Department of RadiologyUniversity College London HospitalLondonUK
  3. 3.Department of PaediatricsUniversity College London HospitalLondonUK
  4. 4.Department of Medical Physics and BioengineeringUniversity College LondonLondonUK
  5. 5.Institute of Nuclear MedicineUniversity College HospitalLondonUK

Personalised recommendations