Department of Radiology, University Medical Center Utrecht, The Netherlands.
AJR Am J Roentgenol. 2011 Mar;196(3):662-9. doi: 10.2214/AJR.10.4743.
The purpose of this study was to compare whole-body MRI including diffusion-weighted imaging (DWI) with (18)F-FDG PET/CT in the staging of newly diagnosed lymphoma.
Twenty-two consecutively registered patients with newly diagnosed lymphoma prospectively underwent whole-body MRI (22 with T1-weighted, STIR, and DWI sequences and 21 with T1-weighted and STIR sequences but not DWI) and FDG PET/CT. Whole-body MRI-DWI was independently evaluated by two blinded observers. Interobserver agreement was assessed, and whole-body MRI-DWI was compared with FDG PET/CT.
The kappa values for interobserver agreement on whole-body MRI-DWI for all nodal regions together and for all extranodal regions together were 0.676 and 0.452. The kappa values for agreement between whole-body MRI-DWI and FDG PET/CT for all nodal regions together and for all extranodal regions together were 0.597 and 0.507. Ann Arbor stage according to whole-body MRI-DWI findings was concordant with that of FDG PET/CT findings in 77% (17/22) of patients. Understaging and overstaging relative to the findings with FDG PET/CT occurred in 0% (0/22) and 23% (5/22) of cases. In the care of 9% (2/22) of patients, overstaging with whole-body MRI-DWI relative to staging with FDG PET/CT would have had therapeutic consequences.
Our early results indicate that overall interobserver agreement on whole-body MRI-DWI findings is moderate to good. Overall agreement between whole-body MRI-DWI and FDG PET/CT is moderate. In the care of patients with newly diagnosed lymphoma, staging with whole-body MRI-DWI does not result in underestimation of stage relative to the results with FDG PET/CT. In a minority of patients, reliance on whole-body MRI-DWI leads to clinically important overstaging relative to the results with FDG PET/CT. FDG PET/CT remains the reference standard for lymphoma staging until larger-scale studies show that use of whole-body MRI-DWI results in correct staging in this minority of cases.
本研究旨在比较全身 MRI （包括弥散加权成像[DWI]）与（18）F-FDG PET/CT 在新诊断淋巴瘤分期中的作用。
22 例连续登记的新诊断淋巴瘤患者前瞻性地接受全身 MRI（22 例采用 T1 加权、短 TI 反转恢复[STIR]和 DWI 序列，21 例采用 T1 加权和 STIR 序列但无 DWI）和 FDG PET/CT。两位盲法观察者独立评估全身 MRI-DWI。评估观察者间一致性，比较全身 MRI-DWI 与 FDG PET/CT。
对于所有淋巴结区域和所有结外区域，全身 MRI-DWI 的观察者间一致性的kappa 值分别为 0.676 和 0.452。对于所有淋巴结区域和所有结外区域，全身 MRI-DWI 与 FDG PET/CT 的一致性的 kappa 值分别为 0.597 和 0.507。根据全身 MRI-DWI 结果进行的 Ann Arbor 分期与 FDG PET/CT 结果一致的患者占 77%（17/22）。相对于 FDG PET/CT，低估分期和高估分期分别发生在 0%（0/22）和 23%（5/22）的病例中。在 9%（2/22）的患者中，全身 MRI-DWI 相对于 FDG PET/CT 分期会导致治疗后果的高估。
我们的初步结果表明，全身 MRI-DWI 结果的总体观察者间一致性为中等至良好。全身 MRI-DWI 与 FDG PET/CT 的总体一致性为中等。在新诊断淋巴瘤患者的治疗中，相对于 FDG PET/CT，全身 MRI-DWI 分期不会导致分期低估。在少数患者中，相对于 FDG PET/CT，单纯依赖全身 MRI-DWI 会导致分期的过度高估，这具有重要的临床意义。在更大规模的研究表明全身 MRI-DWI 在这少数病例中能正确分期之前，FDG PET/CT 仍然是淋巴瘤分期的参考标准。
