King Kenneth Cheung PhD, Presenter: Nothing to Disclose

Nicholas Skipper, Abstract Co-Author: Nothing to Disclose

Sharon Hain FRANZC, Abstract Co-Author: Nothing to Disclose

Elli Kalliopi Papantoniou MBBS, BSc, Abstract Co-Author: Nothing to Disclose

Paul David Humphries MRCP, FRCR, Abstract Co-Author: Nothing to Disclose

Shonit Punwani MBBS, Abstract Co-Author: Nothing to Disclose

Identification of focal splenic involvement in paediatric and adolescent patients with lymphoma upstages disease and escalates treatment. Advances in MR imaging may allow a non-ionising alternative for initial staging of lymphoma, but correct determination of focal splenic involvement will be crucial if other ionising modalities are to be replaced. This study compares the accuracy of Short Tau Inversion Recovery - Half Fourier Single Shot Turbo Spin Echo (STIR-HASTE) MR imaging and PET-CT of the spleen with an expert panel derived reference standard based on multi-disciplinary team review and post-treatment follow up imaging.

A retrospective search was performed of the local radiology and oncology database for histologically proven cases of paediatric and adolescent lymphoma. 34 cases met the inclusion criteria of: 1) Age <18 years; 2) Histologically-confirmed lymphoma; and 3) Both Short Tau Inversion Recovery - Half Fourier Acquisition Single Shot Turbe Spin Echo (STIR-HASTE) MRI and PET/CT pre-treatment staging studies of the spleen available. MR and PET/CT images were anonymised and reviewed by two nuclear medicine physicians and radiologists respectively for presence of focal splenic lesions. Images from each modality were first reviewed independently to evaluate reader concordance, and subsequently in consensus to assess agreement between the two modalities. To determine the sensitivity and specificity of STIR-HASTE MRI and PET/CT for detecting splenic disease, the consensus findings were compared to an enhanced reference standard, based on MDT review and follow-up imaging. Sensitivity and specificity of MRI and PET-CT was determined against the enhanced reference standard.

Sensitivity and specificity for detecting focal splenic disease were both 100% for STIR-HASTE MRI, and was 75% and 88% respectively for PET/CT. Reader concordance was 85% for STIR-HASTE MRI (κ=0.64, 95% CI: 0.35-0.93) and 88% for PET/CT (κ=0.67, 95% CI: 0.38-0.97). MRI and PET/CT findings were in agreement in 90% of the cases (κ=0.74, 95% CI: 0.40-1.0).

STIR-HASTE MR imaging can accurately detect focal splenic disease in lymphoma and demonstrates good agreement and comparable reader concordance with PET-CT.

STIR-HASTE MRI can accurately detect splenic disease in lymphoma. This limits the need for repeated PET/CT, which consequently may reduce risk of radiation-induced secondary malignancy.

Cheung, K, Skipper, N, Hain, S, Papantoniou, E, Humphries, P, Punwani, S, Comparison of STIR-HASTE MR Imaging and PET-CT for Detection of Focal Splenic Disease in Paediatric and Adolescent Patients with Lymphoma.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9011655.html