Centre for Medical Imaging, University College London, 2nd floor, Charles Bell House, 43-45 Foley St., London, W1W 7TS, UK.
Department of Radiology, University College London Hospitals, London, UK.
Pediatr Radiol. 2019 Sep;49(10):1285-1298. doi: 10.1007/s00247-019-04463-9. Epub 2019 Jul 22.
Whole-body MRI is used for staging paediatric Hodgkin lymphoma, commonly using size thresholds, which fail to detect disease in normal-size lymph nodes.
To investigate quantitative whole-body MRI metrics for nodal characterisation.
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). Flourine-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 mm s) to 5- to 9-mm nodes.
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 mm s, respectively.
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.
全身 MRI 用于分期儿科霍奇金淋巴瘤，通常使用大小阈值，但不能检测到正常大小淋巴结中的疾病。
研究用于淋巴结特征描述的定量全身 MRI 指标。
37 例霍奇金淋巴瘤患儿接受 1.5T 全身 MRI 检查，采用短回波时间反转恢复（STIR）半傅里叶采集单次激发涡轮自旋回波和弥散加权成像（DWI）。氟-2-氟-2-脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/CT 作为参考标准。两名独立的读者评估了 11 个淋巴结部位。读者测量了每个部位最大淋巴结的短轴直径、表观弥散系数（ADC）和归一化 T2 信号强度。我们使用接收器工作特征（ROC）/曲线下面积（AUC）分析对每个 MRI 指标进行评估，并得出短轴直径≥10mm 时的淋巴结的灵敏度和特异性。应用 ADC 截断值（<0.77、<1.15 和<1.79×10mm/s）对 5-9mm 淋巴结进行亚组分析，得出灵敏度和特异性。
读者 1/读者 2 的 ROC/AUC 值分别为 DWI 和 STIR 半傅里叶采集单次激发涡轮自旋回波测量的短轴直径为 0.80/0.80 和 0.81/0.81；归一化 T2 信号强度为 0.67/0.72，ADC 为 0.74/0.67。读者 1 和读者 2 的短轴直径≥10mm 的灵敏度和特异性分别为 84.2%和 66.7%，82.9%和 68.9%。应用短轴直径≥10mm 阈值，然后对正常大小 5-9mm 淋巴结应用 ADC 截断值，读者 1 的灵敏度和特异性分别为 88.8%和 60%、92.1%和 56.7%以及 100%和 16.7%；读者 2 的灵敏度和特异性分别为 86.1%和 67.2%、95.3%和 65.6%以及 100%和 19.7%；ADC 截断值分别为<0.77、<1.15 和<1.79×10mm/s。
淋巴结大小测量为儿科霍奇金淋巴瘤的淋巴结疾病状态提供了最佳的单一分类器。与单纯的大小分类相比，短轴直径和 ADC 阈值的联合应用可略微提高灵敏度并降低特异性。
