CME Journal of Clinical Case Reports

The Role of Whole Body MRI With Diffusion Sequence Versus FDGPet/ Ct: A Comparative Study in Pediatric Patients With Hodgkin Lymphoma From Diagnosis to End of Treatment

Abstract

Lederman, H.M, Grassi, DC, Melo, A.Cand Luisi, F

Background In pediatric oncology, minimizing exposure to ionizing radiation is crucial due to the potential long-term risks, including the development of secondary malignancies. For pediatric patients with Hodgkin lymphoma, identifying radiation-free imaging methods that can reliably replace conventional techniques is a clinical priority.

Objective To evaluate the correlation between whole-body magnetic resonance imaging with diffusion-weighted imaging (WB-MRI/ DWI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) findings in pediatric patients with Hodgkin lymphoma, and to determine whether WB-MRI/DWI can serve as a viable alternative in staging and follow-up protocols.

Materials and Methods This single-center retrospective study included pediatric patients aged 6.6–17.0 years (mean ± SD: 14.9 ± 3.2 years) with histopathological confirmed Hodgkin lymphoma who underwent both WB-MRI/DWI and FDG-PET/CT. Imaging was performed with an average interval of 7.6 ± 4.9 days, one from the other. Two radiologists independently evaluated all studies, recording the number of sites involved. per exam and adding all of them for a more precise number. Pearson correlation coefficients and Kappa agreement analyses were performed, using FDG-PET/CT as the reference standard.

Results Among 45 patients (28 male [62,3%], 17 females [37,7%]), 204 sites were positive on FDG-PET/CT and 270 on WB-MRI/DWI. There was a strong correlation between WB-MRI/DWI and FDG-PET/CT for both the number of positive sites (r = 0.831, p < 0.001). WBMRI/DWI demonstrated 96% sensitivity, 95% specificity, an overall agreement of 95.2%, and a Kappa index of 0.8004 (p < 0.001).

Conclusion WB-MRI/DWI shows excellent agreement with FDG-PET/CT for the evaluation of Hodgkin lymphoma in pediatric patients and may represent a safe, effective, and radiation-free alternative for staging and follow-up in this population.

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