Can whole body magnetic resonance imaging replace X-ray computed tomography, bone scan and biopsy in the diagnosis of bone marrow involvement in patients with lymphoma? Comparison of their diagnostic and economic effectiveness
N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus
Vestnik VGMU. 2017;16(1):59-70.
Objectives. To evaluate the effectiveness of whole body magnetic resonance imaging (MRI) in the diagnosis of bone marrow (BM) involvement in patients with lymphoma compared with X-ray computed tomography (CT), bone scan (BS) and BM biopsy as well as to determine whether whole body MRI can replace these studies as a sole method of BM involvement diagnosis.
Material and methods. The study prospectively included 85 patients with lymphoma. All patients underwent pretreatment CT and MRI of the neck, thorax, abdomen and pelvis, BM biopsy with cytological and histological examination. In some patients BS was performed. The effectiveness of these methods in the diagnosis of BM involvement was compared. Economic effectiveness of the whole body MRI as compared to the complex of methods including CT, BS and BM biopsy was evaluated.
Results. Hodgkin’s lymphoma (HL) occurred in 38 patients, non-Hodgkin’s lymphomas (NHL) – in 47. The frequency of BM involvement in HL was 21%, in NHL – 38%. The sensitivity of CT in the diagnosis of BM involvement made up 19%, specificity – 98%, accuracy – 74%, that of BM biopsy – 58%, 100% and 87%, that of MRI – 85%, 97% and 93%, that of the complex of methods including CT, BS and BM biopsy – 73%, 97% and 89%, respectively. The sensitivity of MRI in HL was 100%, that of biopsy – 0%, that of the complex of methods – 38%, in NHL – 78%, 83% and 89%, respectively. The cost of the whole body MRI was lower compared to the cost of the complex of methods.
Conclusions. The whole body MRI can replace CT, BS and BM biopsy in the diagnosis of BM involvement in patients with HL. In patients with NHL, in order to increase the diagnostic effectiveness of MRI, it is necessary to explore the possibilities of new scanning techniques, diffusion-weighed imaging included.
Key words: lymphoma, bone marrow, magnetic resonance imaging, computed tomography, bone scan, biopsy, economic effectiveness.
1. Zhang QY, Foucar K. Bone marrow involvement by hodgkin and non-hodgkin lymphomas. Hematol Oncol Clin North Am. 2009 Aug;23(4):873-902. doi: http://dx.doi.org/10.1016/j.hoc.2009.04.014
2. Khoruzhik SA, Zhavrid EA, Sachivko NV. Lymphoma staging system: historical aspects and current state. Onkol Zhurn. 2014;8():66-72. (In Russ.)
3. Adams HJ, Kwee TC, Lokhorst HM, Westerweel PE, Fijnheer R, Kersten MJ, et al. Potential prognostic implications of whole-body bone marrow MRI in diffuse large B-cell lymphoma patients with a negative blind bone marrow biopsy. J Magn Reson Imaging. 2014 Jun;39(6):1394-400. doi: http://dx.doi.org/10.1002/jmri.24318
4. Khoruzhik SA, Zhavrid EA, Sachivko NV, Portasova NP, Karman EI, Karman AV. Possibilities of whole-body diffusion-weighted magnetic resonance imaging compared to X-ray computed tomography in staging lymphoma. Onkol Zhurn. 2015;9(1):43-8. (In Russ.)
5. Shavladze ZN, Berezovskaya TP, Neledov DV, Kiseleva EA, Pavlov VV, Danilova MA. Bone lesions in Hodgkin's lymphoma: possibilities of CT and MRI diagnosis. Radiologiia - Praktika. 2007;(6):33-41. (In Russ.)
6. Sukonko OG, Krasnyy SA, red. Algorithms of diagnostics and treatment of malignant neoplasms: sb nauch st: osnovan v 2007 g Vyp 2. Minsk, RB: Prof izd; 2012. 508 р. (In Russ.)
7. Khoruzhik SA, Leusik EA. Repeated computer and tomographic researches: exposure doses and radiative risk at malignant lymphoma. Radiatsion Biologiia Radioekologiia. 2014;54(5):466-73. (In Russ.)
8. Lecouvet FE, El Mouedden J, Collette L, Coche E, Danse E, Jamar F, et al. Can whole-body magnetic resonance imaging with diffusion-weighted imaging replace Tc 99m bone scanning and computed tomography for single-step detection of metastases in patients with high-risk prostate cancer? Eur Urol. 2012 Jul;62(1):68-75. doi: http://dx.doi.org/10.1016/j.eururo.2012.02.020
9. Hoane BR, Shields AF, Porter BA, Shulman HM. Detection of lymphomatous bone marrow involvement with magnetic resonance imaging. Blood. 1991 Aug;78(3):728-38.
10. Adams HJ, Kwee TC, Vermoolen MA, de Keizer B, de Klerk JM, Adam JA, et al. Whole-body MRI for the detection of bone marrow involvement in lymphoma: prospective study in 116 patients and comparison with FDG-PET. Eur Radiol. 2013 Aug;23(8):2271-8. doi: http://dx.doi.org/10.1007/s00330-013-2835-9
11. Kwee TC, de Klerk JM, Nievelstein RA. Imaging of bone marrow involvement in lymphoma: state of the art and future directions. ScientificWorldJournal. 2011 Feb;11:391-402. doi: http://dx.doi.org/10.1100/tsw.2011.40
12. Shavladze ZN, Neledov DV, Berezovskaya TP. A magnetic and resonant tomography in diagnostics and monitoring of treatment of a lesion of marrow at Hodzhkin's lymphoma. Onkogematologiia. 2012;(2):28-36. (In Russ.)
13. Khoruzhik SA, Zhavrid EA, Sachivko NV. The diffusive weighed magnetic and resonant tomography with calculation of the measured diffusion coefficient when monitoring and early forecasting of regression of the tumoral centers in the course of a chemotherapy of lymphoma. Med Vizualizatsiia. 2015;(5):83-99. (In Russ.)
14. Linden A, Zankovich R, Theissen P, Diehl V, Schicha H. Malignant lymphoma: bone marrow imaging versus biopsy. Radiology. 1989 Nov;173(2):335-9.
15. Iizuka-Mikami M, Nagai K, Yoshida K, Sugihara T, Suetsugu Y, Mikami M, et al. Detection of bone marrow and extramedullary involvement in patients with non-Hodgkin's lymphoma by whole-body MRI: comparison with bone and 67Ga scintigraphies. Eur Radiol. 2004 Jun;14(6):1074-81. doi: http://dx.doi.org/10.1007/s00330-003-2209-9
Information about authors:
Kharuzhyk S.A. – Candidate of Medical Sciences, associate professor, MRI physician of the radiology department, N.N. Alexandrov National Cancer Centre of Belarus.