Whole-body MRI for initial staging of paediatric lymphoma: Prospective comparison to an FDG-PET/CT-based reference standard

Annemieke S. Littooij, Thomas C. Kwee, Ignasi Barber, Claudio Granata, Malou A. Vermoolen, Goya Enríquez, József Zsíros, Shui Yen Soh, Bart De Keizer, Frederik J A Beek, Monique G. Hobbelink, Marc B. Bierings, Jaap Stoker, Rutger A J Nievelstein

Research output: Contribution to journalArticle


Objective: To compare whole-body MRI, including diffusion-weighted imaging (whole-body MRI-DWI), with FDG-PET/CT for staging newly diagnosed paediatric lymphoma. Methods: A total of 36 children with newly diagnosed lymphoma prospectively underwent both whole-body MRI-DWI and FDG-PET/CT. Whole-body MRI-DWI was successfully performed in 33 patients (mean age 13.9 years). Whole-body MRI-DWI was independently evaluated by two blinded observers. After consensus reading, an unblinded expert panel evaluated the discrepant findings between whole-body MRI-DWI and FDG-PET/CT and used bone marrow biopsy, other imaging data and clinical information to derive an FDG-PET/CT-based reference standard. Results: Interobserver agreement of whole-body MRI-DWI was good [all nodal sites together (κ = 0.79); all extranodal sites together (κ = 0.69)]. There was very good agreement between the consensus whole-body MRI-DWI- and FDG-PET/CT-based reference standard for nodal (κ = 0.91) and extranodal (κ = 0.94) staging. The sensitivity and specificity of consensus whole-body MRI-DWI were 93 % and 98 % for nodal staging and 89 % and 100 % for extranodal staging, respectively. Following removal of MRI reader errors, the disease stage according to whole-body MRI-DWI agreed with the reference standard in 28 of 33 patients. Conclusions: Our results indicate that whole-body MRI-DWI is feasible for staging paediatric lymphoma and could potentially serve as a good radiation-free alternative to FDG-PET/CT. Keypoints: • Accurate staging is important for treatment planning and assessing prognosis • Whole-body MRI-DWI could be a good radiation-free alternative to FDG-PET/CT • Interobserver agreement of whole-body MRI-DWI is good • Agreement between whole-body MRI and the FDG-PET/CT reference standard is good • Most discrepancies were caused by suboptimal accuracy of size measurements on MRI.

Original languageEnglish
Pages (from-to)1153-1165
Number of pages13
JournalEuropean Radiology
Issue number5
Publication statusPublished - 2014



  • Children and adolescents
  • Diffusion-weighted imaging
  • Lymphoma
  • Whole-body MRI

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Littooij, A. S., Kwee, T. C., Barber, I., Granata, C., Vermoolen, M. A., Enríquez, G., Zsíros, J., Soh, S. Y., De Keizer, B., Beek, F. J. A., Hobbelink, M. G., Bierings, M. B., Stoker, J., & Nievelstein, R. A. J. (2014). Whole-body MRI for initial staging of paediatric lymphoma: Prospective comparison to an FDG-PET/CT-based reference standard. European Radiology, 24(5), 1153-1165. https://doi.org/10.1007/s00330-014-3114-0