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Whole-body MRI for the detection of bone marrow involvement in lymphoma: prospective study in 116 patients and comparison with FDG-PET

  • Oncology
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Abstract

Objective

To assess and compare the value of whole-body MRI with FDG-PET for detecting bone marrow involvement in lymphoma.

Methods

A total of 116 patients with newly diagnosed lymphoma prospectively underwent whole-body MRI and blind bone marrow biopsy (BMB) of the posterior iliac crest. Of 116 patients, 80 also underwent FDG-PET. Patient-based sensitivities of whole-body MRI for detecting bone marrow involvement were calculated using BMB as reference standard and compared with FDG-PET in aggressive and indolent lymphomas separately.

Results

Sensitivity of whole-body MRI in all lymphomas was 45.5 % [95 % confidence interval (CI): 29.8–62.0 %]. Sensitivity of whole-body MRI in aggressive lymphoma [88.9 % (95 % CI: 54.3–100 %)] was significantly higher (P = 0.0029) than that in indolent lymphoma [23.5 % (95 % CI: 9.1–47.8 %)]. Sensitivity of FDG-PET in aggressive lymphoma [83.3 % (95 % CI: 41.8–98.9 %)] was also significantly higher (P = 0.026) than that in indolent lymphoma [12.5 % (95 % CI: 0–49.2 %)]. There were no significant differences in sensitivity between whole-body MRI and FDG-PET (P = 1.00)

Conclusion

Sensitivity of whole-body MRI for detecting lymphomatous bone marrow involvement is too low to (partially) replace BMB. Sensitivity of whole-body MRI is significantly higher in aggressive lymphoma than in indolent lymphoma and is equal to FDG-PET in both entities.

Key Points

• Bone marrow involvement in lymphoma has prognostic and therapeutic implications.

• Blind bone marrow biopsy (BMB) is standard for bone marrow assessment.

• Neither whole-body MRI nor FDG-PET can yet replace BMB.

• Both techniques have higher sensitivity in aggressive than in indolent lymphoma.

• Both imaging techniques are complementary to BMB.

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Acknowledgments

This project was financially supported by the Dutch Organisation for Health Research and Development (ZonMw) Programme for Health Care Efficiency Research (grant no. 80-82310-98-08012) and by a ZonMW AGIKO stipend (grant no. 92003497). Data collection, data analysis and interpretation of data, writing of the paper and the decision to submit were left to the authors’ discretion and were not influenced by ZonMw.

Forty-eight of 116 included patients were included in our previously published preliminary analysis (Kwee TC, Fijnheer R, Ludwig I, et al. (2010) Whole-body magnetic resonance imaging, including diffusion-weighted imaging, for diagnosing bone marrow involvement in malignant lymphoma. Br J Haematol 149:628–630). In that previous study, however, no definitive conclusions could be drawn, no comparison was made with FDG-PET, and no analyses were made for aggressive and indolent lymphomas separately. The present study provides substantially new information and allows drawing more definitive conclusions.

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Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Hugo J. A. Adams, Thomas C. Kwee, Malou A. Vermoolen, Bart de Keizer & Rutger A. J. Nievelstein

  2. Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands

    John M. H. de Klerk

  3. Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands

    Judit A. Adam

  4. Department of Hematology, Meander Medical Center, Amersfoort, The Netherlands

    Rob Fijnheer

  5. Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands

    Marie José Kersten

  6. Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands

    Jaap Stoker

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  1. Hugo J. A. Adams
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Corresponding author

Correspondence to Thomas C. Kwee.

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Adams, H.J.A., Kwee, T.C., Vermoolen, M.A. et al. Whole-body MRI for the detection of bone marrow involvement in lymphoma: prospective study in 116 patients and comparison with FDG-PET. Eur Radiol 23, 2271–2278 (2013). https://doi.org/10.1007/s00330-013-2835-9

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