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Pediatric Radiology
Published in: Pediatric Radiology 10/2019

Open Access 01-09-2019 | Magnetic Resonance Imaging | Original Article

Whole-body magnetic resonance imaging in paediatric Hodgkin lymphoma — evaluation of quantitative magnetic resonance metrics for nodal staging

Authors: Arash Latifoltojar, Paul D. Humphries, Leon J. Menezes, Athar Haroon, Stephen Daw, Ananth Shankar, Shonit Punwani

Published in: Pediatric Radiology | Issue 10/2019

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Abstract

Background

Whole-body MRI is used for staging paediatric Hodgkin lymphoma, commonly using size thresholds, which fail to detect disease in normal-size lymph nodes.

Objective

To investigate quantitative whole-body MRI metrics for nodal characterisation.

Materials and methods

Thirty-seven children with Hodgkin lymphoma underwent 1.5-tesla (T) whole-body MRI using short tau inversion recovery (STIR) half-Fourier-acquisition single-shot turbo-spin-echo and diffusion-weighted imaging (DWI). 18Flourine-2-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET)/CT was acquired as the reference standard. Two independent readers assessed 11 nodal sites. The readers measured short-axis-diameter, apparent diffusion coefficient, (ADC) and normalised T2-signal intensity of the largest lymph node at each site. We used receiver operating characteristics (ROC)/area-under-the-curve (AUC) analysis for each MRI metric and derived sensitivity and specificity for nodes with short-axis diameter ≥10 mm. Sub-analysis of sensitivity and specificity was performed with application of ADC cut-off values (<0.77, <1.15 and <1.79×10−3 mm2 s−1) to 5- to 9-mm nodes.

Results

ROC/AUC values for reader 1/reader 2 were 0.80/0.80 and 0.81/0.81 for short-axis-diameter measured using DWI and STIR half-Fourier-acquisition single-shot turbo spin echo, respectively; 0.67/0.72 for normalised T2 signal intensity and 0.74/0.67 for ADC. Sensitivity and specificity for a short-axis diameter ≥10 mm were 84.2% and 66.7% for Reader 1 and 82.9% and 68.9% for Reader 2. Applying a short-axis-diameter ≥10-mm threshold followed by ADC cut-offs to normal-size 5- to 9-mm nodes resulted in sensitivity and specificity for Reader 1 of 88.8% and 60%, 92.1% and 56.7%, and 100% and 16.7%; and for Reader 2, 86.1% and 67.2%, 95.3% and 65.6%, and 100% and 19.7%; and ADC thresholds of <0.77, <1.15, and <1.79×10−3 mm2 s−1, respectively.

Conclusion

Nodal size measurement provides the best single classifier for nodal disease status in paediatric Hodgkin lymphoma. Combined short-axis diameter and ADC thresholds marginally improve sensitivity and drop specificity compared with size classification alone.
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Metadata
Title
Whole-body magnetic resonance imaging in paediatric Hodgkin lymphoma — evaluation of quantitative magnetic resonance metrics for nodal staging
Authors
Arash Latifoltojar
Paul D. Humphries
Leon J. Menezes
Athar Haroon
Stephen Daw
Ananth Shankar
Shonit Punwani
Publication date
01-09-2019
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 10/2019
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-019-04463-9

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