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PET/MRI in Lymphoma

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PET/MRI in Oncology

Abstract

Hybrid PET/MR combines two advanced imaging techniques, offering the potential to improve image quality, reduce radiation dose and combine functional information from MR (dynamic contrast-enhanced sequences, diffusion-weighted imaging and magnetic resonance spectroscopy) with PET in the management of lymphoma. The reduction in radiation dose afforded by PET/MR in Hodgkin lymphoma, which is the commonest cancer in teenagers and young adults, is particularly appealing. PET/MR reduces radiation dose by approximately 60–77% compared with PET combined with full-dose diagnostic CT and 20–27% compared with PET combined with lower-dose CT.

To date, studies directly comparing PET/MR with PET/CT suggest they are likely equivalent for staging, although data regarding extranodal involvement are more limited than nodal lymphoma. Whole-body diffusion-weighted imaging (DWI) in isolation has been reported to provide similar staging information to half-body PET/CT without incurring any radiation, but DWI misses a substantial number of lesions and introduces some ‘false positive’ lesions when compared to PET/CT depending on the DWI criteria used to establish involvement, which are not currently standardised. This is a significant limitation when assessing sites of involvement on repeat imaging for response assessment. DWI does not appear to add value in addition to anatomical sequences in PET/MR at the current time.

PET/MR probably underestimates FDG uptake compared to PET/CT and MR attenuation in comparative studies, and correction algorithms will need to be optimised before PET/MR can replace PET/CT in most cases for response assessment using recommended international criteria with the five-point ‘Deauville’ scale.

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Acknowledgements

King’s College London and UCL Comprehensive Cancer Imaging Centre. Funded by the CRUK and EPSRC in association with the MRC and DoH (England).

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Authors and Affiliations

  1. School of Biomedical Engineering and Imaging Sciences, King’s College London and Guy’s & St Thomas’ PET Centre, King’s College London, King’s Health Partners, St. Thomas’ Hospital, London, UK

    Sally F. Barrington

  2. Division of Nuclear Medicine, Department of Radiology, NYU Langone Medical Center, New York, NY, USA

    Kent Friedman

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  1. Sally F. Barrington
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Correspondence to Sally F. Barrington .

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  1. Division of Nuclear Medicine and Molecular Imaging, Stanford University, Stanford, CA, USA

    Andrei Iagaru

  2. Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA

    Thomas Hope

  3. Dept. of Nuclear Medicine, University of Zurich, Zurich, Switzerland

    Patrick Veit-Haibach

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Barrington, S.F., Friedman, K. (2018). PET/MRI in Lymphoma. In: Iagaru, A., Hope, T., Veit-Haibach, P. (eds) PET/MRI in Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-68517-5_20

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