Comparison of Nasopharyngeal MR, 18 F-FDG PET/CT, and 18 F-FDG PET/MR for Local Detection of Natural Killer/T-Cell Lymphoma, Nasal Type

Rui Guo; Pengpeng Xu; Shu Cheng; Mu Lin; Huijuan Zhong; Weixia Li; Hengye Huang; Bingsheng Ouyang; Hongmei Yi; Jiayi Chen; Xiaozhu Lin; Kuangyu Shi; Weili Zhao; Biao Li

doi:10.3389/fonc.2020.576409

Comparison of Nasopharyngeal MR, ¹⁸ F-FDG PET/CT, and ¹⁸ F-FDG PET/MR for Local Detection of Natural Killer/T-Cell Lymphoma, Nasal Type

Front Oncol. 2020 Oct 14:10:576409. doi: 10.3389/fonc.2020.576409. eCollection 2020.

Authors

Rui Guo¹, Pengpeng Xu², Shu Cheng², Mu Lin³, Huijuan Zhong², Weixia Li⁴, Hengye Huang⁵, Bingsheng Ouyang⁶, Hongmei Yi⁶, Jiayi Chen⁷, Xiaozhu Lin¹, Kuangyu Shi^{8

9}, Weili Zhao², Biao Li¹

Affiliations

¹ Department of Nuclear Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
² State Key Laboratory of Medical Genomics, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
³ Siemens Healthcare, Beijing, China.
⁴ Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
⁵ School of Public Health, Shanghai Jiao Tong University, Shanghai, China.
⁶ Department of Pathology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
⁷ Department of Radiation, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
⁸ Department of Nuclear Medicine, University Hospital Bern, Bern, Switzerland.
⁹ Faculty of Informatics, Technical University of Munich, Munich, Germany.

Abstract

Objectives: The present study aims to compare the diagnostic efficacy of MR, ¹⁸F-FDG PET/CT, and ¹⁸F-FDG PET/MR for the local detection of early-stage extranodal natural killer/T-cell lymphoma, nasal type (ENKTL).

Patients and methods: Thirty-six patients with histologically proven early-stage ENKTL were enrolled from a phase 2 study (Cohort A). Eight nasopharyngeal anatomical regions from each patient were imaged using ¹⁸F-FDG PET/CT and MR. A further nine patients were prospectively enrolled from a multicenter, phase 3 study; these patients underwent ¹⁸F-FDG PET/CT and PET/MR after a single ¹⁸F-FDG injection (Cohort B). Region-based sensitivity and specificity were calculated. The standardized uptake values (SUV) obtained from PET/CT and PET/MR were compared, and the relationship between the SUV and apparent diffusion coefficients (ADC) of PET/MR were analyzed.

Results: In Cohort A, of the 288 anatomic regions, 86 demonstrated lymphoma involvement. All lesions were detected by ¹⁸F-FDG PET/CT, while only 70 were detected by MR. ¹⁸F-FDG PET/CT exhibited a higher sensitivity than MR (100% vs. 81.4%, χ² = 17.641, P < 0.001) for local detection of malignancies. The specificity of ¹⁸F-FDG PET/CT and MR were 98.5 and 97.5%, respectively (χ² = 0.510, P = 0.475). The accuracy of ¹⁸F-FDG PET/CT was 99.0% and the accuracy of MR was 92.7% (χ² = 14.087, P < 0.001). In Cohort B, 72 anatomical regions were analyzed. PET/CT and PET/MR have a sensitivity of 100% and a specificity of 92.5%. The two methods were consistent (κ = 0.833, P < 0.001). There was a significant correlation between PET/MR SUVmax and PET/CT SUVmax (r = 0.711, P < 0.001), and SUVmean (r = 0.685, P < 0.001). No correlation was observed between the SUV and the ADC.

Conclusion: In early-stage ENKTL, nasopharyngeal MR showed a lower sensitivity and a similar specificity when compared with ¹⁸F-FDG PET/CT. PET/MR showed similar performance compared with PET/CT.

Keywords: 18F-FDG; MR; PET/CT; PET/MR; extranodal NK/T-cell lymphoma; nasal-type.