Whole-body diffusion-weighted imaging with background body signal suppression and quantitative apparent diffusion coefficient in the detection, staging, and grading of non-Hodgkin lymphoma
More details
Hide details
Submission date: 2022-05-31
Final revision date: 2022-10-05
Acceptance date: 2022-12-29
Publication date: 2023-03-31
Pol J Radiol, 2023; 88: 177-186
Assess reproducibility of detection, staging, and grading of non-Hodgkin lymphoma (NHL) using whole-body diffusion-weighted imaging with background body signal suppression (WB-DWIBS).

Material and methods:
Thirty NHL patients underwent WB-DWIBS, divided into 2 groups according to staging and grading. Image analysis and apparent diffusion coefficient (ADC) measurement of the largest lymph node in each group were performed by 2 observers. Inter-observer agreement was performed.

Overall inter-observer agreement for detection of NHL was excellent (κ = 0.843; 92.05%) with excellent inter-observer agreement of nodal disease (cervical, thoracic and abdominal) (κ = 0.783, 0.769, and 0.856; 96.67%, 90.0%, and 93.3% respectively), extra-nodal disease (κ = 1; 100%), and splenic involvement (κ = 0.67; 83.3%). The overall inter-observer agreement of DWIBS in staging of NHL was excellent (κ = 0.90; 94.9%) with excellent inter-observer agreement for stage I (κ = 0.93; 96.4%), stage II (κ = 0.90; 94.8%), stage III (κ = 0.89; 94.6%), and stage IV (κ = 0.88; 94.0%). There was significant difference between ADC in stage I, II (0.77 ± 0.13, 0.85 ± 0.09 × 10-3 mm2/s), and stage III, IV (0.63 ± 0.08, 0.64 ± 0.11 × 10-3 mm2/s, p < 0.002, < 0.001). Interclass correlation showed almost perfect agreement for ADC measurement in staging and grading groups (r = 0.96 and r = 0.85, respectively, p < 0.001). There was significant difference between ADC in aggressive lymphoma (0.65 ± 0.1, 0.67 ± 0.13 × 10-3 mm2/s) and indolent lymphoma (0.76 ± 0.14, 0.84 ± 0.09 × 10-3 mm2/s, p < 0.028, < 0.001).

DWIBS is reproducible for detection and staging of nodal and extra-nodal involvement in patients with NHL. ADC can quantitatively participate in the staging and grading of NHL.

Lewis WD, Lilly S, Jones KL. Lymphoma: diagnosis and treatment. Am Fam Physician 2020; 101: 34-41.
Buchbender C, Heusner TA, Lauenstein TC, et al. Oncologic PET/MRI, part 2: bone tumors, soft-tissue tumors, melanoma, and lymphoma. J Nucl Med 2012; 53: 1244-1252.
Maggialetti N, Ferrari C, Minoia C, et al. Role of WB-MR/DWIBS compared to (18) F-FDG PET/CT in the therapy response assessment of lymphoma. Radiol Med 2016; 121: 132-143.
Albano D, La Grutta L, Grassedonio E, et al. Pitfalls in whole body MRI with diffusion weighted imaging performed on patients with lymphoma: what radiologists should know. Magn Reson Imaging 2016; 34: 922-931.
Albano D, Patti C, Lagalla R, et al. Whole-body MRI, FDG-PET/CT, and bone marrow biopsy, for the assessment of bone marrow involvement in patients with newly diagnosed lymphoma. J Magn Reson Imaging 2017; 45: 1082-1089.
Razek AAKA, Shamaa S, Lattif MA, et al. Inter-observer agreement of whole-body computed tomography in staging and response assessment in lymphoma: the Lugano classification. Pol J Radiol 2017; 82: 441-447.
Bezerra ROF, Recchimuzzi DZ, dos Santos Mota MM, et al. Whole-body magnetic resonance imaging in the oncology setting: an overview and update on recent advances. J Comput Assist Tomogr 2019; 43: 66-75.
Kwee TC, Ludwig I, Uiterwaal CS, et al. ADC measurements in the evaluation of lymph nodes in patients with non-Hodgkin lymphoma: feasibility study. MAGMA 2011; 24: 1-8.
De Paepe KN, De Keyzer F, Wolter P, et al. Improving lymph node characterization in staging malignant lymphoma using first-order ADC texture analysis from whole-body diffusion-weighted MRI. J Magn Reson Imaging 2018; 48: 897-906.
Latifoltojar A, Punwani S, Lopes A, et al. Whole-body MRI for staging and interim response monitoring in paediatric and adolescent Hodgkin’s lymphoma: a comparison with multi-modality reference standard including 18F-FDG-PET-CT. Eur Radiol 2019; 29: 202-212.
Montoro J, Laszlo D, Zing NP, et al. Comparison of whole-body diffusion-weighted magnetic resonance and FDG-PET/CT in the assessment of Hodgkin’s lymphoma for staging and treatment response. Ecancermedicalscience 2014; 8: 429. doi: 10.3332/ecancer.2014.429.
Albano D, Agnello F, Patti C, et al. Whole-body magnetic resonance imaging and FDG-PET/CT for lymphoma staging: assessment of patient experience. Egypt J Radiol Nucl Med 2017; 48: 1043-1047.
Petralia G, Padhani AR. Whole-body magnetic resonance imaging in oncology: uses and indications. Magn Reson Imaging Clin N Am 2018; 26: 495-507.
Razek AA, Tawfik A, Rahman MA, et al. Whole-body diffusion-weighted imaging with background body signal suppression in the detection of osseous and extra-osseous metastases. Pol J Radiol 2019; 84: e453-e458. doi: 10.5114/pjr.2019.90057.
Vilanova JC, García-Figueiras R, Luna A, et al. Update on whole-body MRI in musculoskeletal applications. Semin Musculoskelet Radiol 2019; 23: 312-323.
Tunariu N, Blackledge M, Messiou C, et al. What’s new for clinical whole-body MRI (WB-MRI) in the 21st century. Br J Radiol 2020; 93: 20200562. doi: 10.1259/bjr.20200562.
Albano D, Stecco A, Micci G, et al. Whole-body magnetic resonance imaging (WB-MRI) in oncology: an Italian survey. Radiol Med 2021; 126: 299-305.
Petralia G, Koh DM, Attariwala R, et al. Oncologically Relevant Findings Reporting and Data System (ONCO-RADS): guidelines for the acquisition, interpretation, and reporting of whole-body MRI for cancer screening. Radiology 2021; 299: 494-507.
Hynes JP, Hughes N, Cunningham P, et al. Whole-body MRI of bone marrow: a review. J Magn Reson Imaging 2019; 50: 1687-1701.
Albano D, Bruno A, Patti C, et al. Whole-body magnetic resonance imaging (WB-MRI) in lymphoma: state of the art. Hematol Oncol 2020; 38: 12-21.
Zafar S, Sharma RK, Cunningham J, et al. Current and future best practice in imaging, staging, and response assessment for non-Hodgkin’s lymphomas: the Specialist Integrated Haematological Malignancy Imaging Reporting (SIHMIR) paradigm shift. Clin Radiol 2021; 76: 391.e1-391.e18. doi: 10.1016/j.crad.2020.12.022.
Stéphane V, Samuel B, Vincent D, et al. Comparison of PET-CT and magnetic resonance diffusion weighted imaging with body suppression (DWIBS) for initial staging of malignant lymphomas. Eur J Radiol 2013; 82: 2011-2017.
Li S, Xue HD, Li J, et al. Application of whole body diffusion weighted MR imaging for diagnosis and staging of malignant lymphoma. Chin Med Sci J 2008; 23: 138-144.
Littooij AS, Kwee TC, de Keizer B, et al. Whole-body MRI-DWI for assessment of residual disease after completion of therapy in lymphoma: a prospective multicenter study. J Magn Reson Imaging 2015; 42: 1646-1655.
Meleshko AN, Kharuzhyk SA, Piatrouskaya NA. Response monitoring in follicular lymphoma by synchronous evaluation of minimal residual disease and diffusion-weighted MRI. Exp Oncol 2015; 37: 295-297.
Regacini R, Puchnick A, Shigueoka DC, et al. Whole-body diffusion-weighted magnetic resonance imaging versus FDG-PET/CT for initial lymphoma staging: systematic review on diagnostic test accuracy studies. Sao Paulo Med J 2015; 133: 141-150.
Toledano-Massiah S, Luciani A, Itti E, et al. Whole-body diffusion-weighted imaging in Hodgkin lymphoma and diffuse large B-cell lymphoma. Radiographics 2015; 35: 747-764.
Sun M, Cheng J, Zhang Y, et al. Application value of diffusion weighted whole body imaging with background body signal suppression in monitoring the response to treatment of bone marrow involvement in lymphoma. J Magn Reson Imaging 2016; 44: 1522-1529.
Azzedine B, Kahina MB, Dimitri P, et al. Whole-body diffusion-weighted MRI for staging lymphoma at 3.0T: comparative study with MR imaging at 1.5T. Clin Imaging 2015; 39: 104-109.
Kwee TC, Takahara T, Ochiai R, et al. Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS): features and potential applications in oncology. Eur Radiol 2008; 18: 1937-1952.
Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood 2016; 127: 2375-2390.
Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol 2014; 32: 3059-3068.
Cheson BD, Leonard JP. Monoclonal antibody therapy for B-cell non-Hodgkin’s lymphoma. N Engl J Med 2008; 359: 613-626.
Stecco A, Romano G, Negru M, et al. Whole-body diffusion-weighted magnetic resonance imaging in the staging of oncological patients: comparison with positron emission tomography computed tomography (PET-CT) in a pilot study. Radiol Med 2009; 114: 1-17.
Kalkmann J, Lauenstein T, Stattaus J. Whole-body diffusion-weighted imaging in oncology. Technical aspects and practical relevance. Radio­loge 2011; 51: 215-219.
Manenti G, Ciccio C, Squillaci E, et al. Role of combined DWIBS/3D-CE-T1w whole-body MRI in tumor staging: comparison with PET-CT. Eur J Radiol 2012; 81: 1917-1925.
Koh DM, Blackledge M, Padhani AR, et al. Whole-body diffusion weighted MRI: tips, tricks, and pitfalls. AJR Am J Roentgenol 2012; 199: 252-262.
Balbo-Mussetto A, Cirillo S, Bruna R, et al. Whole-body MRI with diffusion-weighted imaging: a valuable alternative to contrast-enhanced CT for initial staging of aggressive lymphoma. Clin Radiol 2016; 71: 271-279.
Kharuzhyk S, Zhavrid E, Dziuban A, et al. Comparison of whole-body MRI with diffusion-weighted imaging and PET/CT in lymphoma staging. Eur Radiol 2020; 30: 3915-3923.
Spijkers S, Littooij AS, Kwee TC, et al. Whole-body MRI versus an FDG-PET/CT-based reference standard for staging of paediatric Hodgkin lymphoma: a prospective multicentre study. Eur Radiol 2021; 31: 1494-1504.
Kwee TC, Vermoolen MA, Akkerman EA, et al. Whole-body MRI, including diffusion-weighted imaging, for staging lymphoma: comparison with CT in a prospective multicenter study. J Magn Reson Imaging 2014; 40: 26-36.
Lin C, Itti E, Luciani A, et al. Whole-body diffusion-weighted imaging in lymphoma. Cancer Imaging 2010; 10 Spec no A(1A): S172-S178. doi: 10.1102/1470-7330.2010.9029.
Gu J, Chan T, Zhang J, et al. Whole-body diffusion-weighted imaging: the added value to whole-body MRI at initial diagnosis of lymphoma. Am J Roentgenol 2011; 197: 384-391.
Perrone A, Guerrisi P, Izzo L, et al. Diffusion-weighted MRI in cervical lymph nodes: differentiation between benign and malignant lesions. Eur J Radiol 2011; 77: 281-286.
Ali TFT. Neck lymph nodes: characterization with diffusion-weighted MRI. Egypt J Radiol Nucl Med 2012; 43: 173-181.
Journals System - logo
Scroll to top