Diagnostic performance of integrated whole-body 18F-FDG PET/MRI for detecting bone marrow involvement in indolent lymphoma: Comparison with 18F-FDG PET or MRI alone

Xuetao Chen; Tingting Yuan; Maomao Wei; Boqi Yu; Nina Zhou; Hua Zhu; Zhi Yang; Xuejuan Wang

doi:10.3389/fonc.2023.1136687

Diagnostic performance of integrated whole-body ¹⁸F-FDG PET/MRI for detecting bone marrow involvement in indolent lymphoma: Comparison with ¹⁸F-FDG PET or MRI alone

Front Oncol. 2023 Mar 13:13:1136687. doi: 10.3389/fonc.2023.1136687. eCollection 2023.

Authors

Xuetao Chen¹, Tingting Yuan¹, Maomao Wei¹, Boqi Yu¹, Nina Zhou¹, Hua Zhu¹, Zhi Yang¹, Xuejuan Wang¹

Affiliation

¹ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), National Medical Products Administration (NMPA) Key Laboratory for Research and Evaluation of Radiopharmaceuticals, Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, China.

Abstract

Purpose: To investigate the diagnostic performance of integrated whole-body ¹⁸F-FDG PET/MRI for detecting bone marrow involvement (BMI) in indolent lymphoma compared with ¹⁸F-FDG PET or MRI alone.

Methods: Patients with treatment-naive indolent lymphoma who underwent integrated whole-body ¹⁸F-FDG PET/MRI and bone marrow biopsy (BMB) were prospectively enrolled. Agreement between PET, MRI, PET/MRI, BMB, and the reference standard was assessed using kappa statistics. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of each method were calculated. A receiver operating characteristic (ROC) curve was used to determine the area under the curve (AUC). AUCs of PET, MRI, PET/MRI, and BMB were compared using the DeLong test.

Results: Fifty-five patients (24 males and 31 females; mean age: 51.1 ± 10.1 years) were included in this study. Of these 55 patients, 19 (34.5%) had BMI. Two patients were upstaged as extra bone marrow lesions were detected via PET/MRI. 97.1% (33/34) of participants were confirmed as BMB-negative in the PET-/MRI-group. PET/MRI (parallel test) and BMB showed excellent agreement with the reference standard (k = 0.843, 0.918), whereas PET and MRI showed moderate agreement (k = 0.554, 0.577). The sensitivity, specificity, accuracy, PPV, and NPV for identifying BMI in indolent lymphoma were 52.6%, 97.2%, 81.8%, 90.9%, and 79.5%, respectively, for PET; 63.2%, 91.7%, 81.8%, 80.0%, and 82.5%, respectively, for MRI; 89.5%, 100%, 96.4%, 100%, and 94.7%, respectively, for BMB; and 94.7%, 91.7%, 92.7%, 85.7%, and 97.1%, respectively, for PET/MRI (parallel test). According to ROC analysis, the AUCs of PET, MRI, BMB, and PET/MRI (parallel test) for detecting BMI in indolent lymphomas were 0.749, 0.774, 0.947, and 0.932, respectively. The DeLong test showed significant differences between the AUCs of PET/MRI (parallel test) and those of PET (P = 0.003) and MRI (P = 0.004). Regarding histologic subtypes, the diagnostic performance of PET/MRI for detecting BMI in small lymphocytic lymphoma was lower than that in follicular lymphoma, which was in turn lower than that in marginal zone lymphoma.

Conclusion: Integrated whole-body ¹⁸F-FDG PET/MRI showed excellent sensitivity and accuracy for detecting BMI in indolent lymphoma compared with ¹⁸F-FDG PET or MRI alone, demonstrating that ¹⁸F-FDG PET/MRI is an optimal method and a reliable alternative to BMB.

Trial registration: ClinicalTrials.gov (NCT05004961 and NCT05390632).

Keywords: MRI; PET; bone marrow biopsy; bone marrow involvement; indolent lymphoma; integrated whole-body 18 F-FDG PET/MRI.

Associated data

ClinicalTrials.gov/NCT05390632
ClinicalTrials.gov/NCT05004961

Grants and funding

This work was financially supported by the National Natural Science Foundation of China (No. 82071957), Capital’s Funds for Health Improvement and Research (No. 2018-2-1024), Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (code: XMLX202120), and Beijing Hope Run Special Fund of Cancer Foundation of China (No. LC2022L04).