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Diagnostic Accuracy of 2-[18F]FDG-PET and whole-body DW-MRI for the detection of bone marrow metastases in children and young adults

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Abstract

Objectives

To compare the diagnostic accuracy of 2-[18F]fluoro-2-deoxy-d-glucose-enhanced positron emission tomography (2-[18F]FDG-PET) and diffusion-weighted magnetic resonance imaging (DW-MRI) for the detection of bone marrow metastases in children and young adults with solid malignancies.

Methods

In this cross-sectional single-center institutional review board-approved study, we investigated twenty-three children and young adults (mean age, 16.8 years ± 5.1 [standard deviation]; age range, 7–25 years; 16 males, 7 females) with 925 bone marrow metastases who underwent 66 simultaneous 2-[18F]FDG-PET and DW-MRI scans including 23 baseline scans and 43 follow-up scans after chemotherapy between May 2015 and July 2020. Four reviewers evaluated all foci of bone marrow metastasis on 2-[18F]FDG-PET and DW-MRI to assess concordance and measured the tumor-to-bone marrow contrast. Results were assessed with a one-sample Wilcoxon test and generalized estimation equation. Bone marrow biopsies and follow-up imaging served as the standard of reference.

Results

The reviewers detected 884 (884/925, 95.5%) bone marrow metastases on 2-[18F]FDG-PET and 893 (893/925, 96.5%) bone marrow metastases on DW-MRI. We found different “blind spots” for 2-[18F]FDG-PET and MRI: 2-[18F]FDG-PET missed subcentimeter lesions while DW-MRI missed lesions in small bones. Sensitivity and specificity were 91.0% and 100% for 18F-FDG-PET, 89.1% and 100.0% for DW-MRI, and 100.0% and 100.0% for combined modalities, respectively. The diagnostic accuracy of combined 2-[18F]FDG-PET/MRI (100.0%) was significantly higher compared to either 2-[18F]FDG-PET (96.9%, p < 0.001) or DW-MRI (96.3%, p < 0.001).

Conclusions

Both 2-[18F]FDG-PET and DW-MRI can miss bone marrow metastases. The combination of both imaging techniques detected significantly more lesions than either technique alone.

Key Points

• DW-MRI and 2-[18F]FDG-PET have different strengths and limitations for the detection of bone marrow metastases in children and young adults with solid tumors.

• Both modalities can miss bone marrow metastases, although the “blind spot” of each modality is different.

• A combined PET/MR imaging approach will achieve maximum sensitivity and specificity for the detection of bone marrow metastases in children with solid tumors.

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Abbreviations

2-[18F]FDG-PET:

2-[18F]fluoro-2-deoxy-d-glucose-enhanced positron emission tomography

ADC:

Apparent diffusion coefficient

CI:

Confidence interval

CT:

Computed tomography

DNA:

Deoxyribonucleic acid

DWI:

Diffusion-weighted imaging

EANM:

European Association of Nuclear Medicine

FOV:

Field of view

GEE:

Generalized estimation equation

GLMM:

Generalized linear mixed model

IRB:

Institutional review board

LAVA:

Liver acquisition with volume acquisition

MIBG:

Metaiodobenzylguanidine

MRI:

Magnetic resonance imaging

NCCN:

National Comprehensive Cancer Network

NHL:

Non-Hodgkin lymphomas

OSEM:

Ordered subset expectation maximization

ROI:

Regions of interest

SD:

Standard deviation

SNMMI:

Society of Nuclear Medicine and Molecular Imaging

SNR:

Signal to noise ratio

SUV:

Standardized uptake value

TE:

Echo time

TR:

Repetition time

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Acknowledgements

We thank Dawn Holley, Kim Halbert, and Mehdi Khalighi from the PET/MRI Metabolic Service Center for their assistance with the acquisition of PET/MRI scans at the Lucas Research Center at Stanford. We thank Hasti Gholami for her help in the preparation of Figure 2. We thank the members of the Daldrup-Link lab for valuable input and discussions regarding this project.

Funding

This work was in part supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, grant number R01 HD081123.

Statistical analysis for this work was also partially supported by the Biostatistics Shared Resources, which is funded by the Cancer Center Support Grant, P30CA124435.

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Authors and Affiliations

  1. Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA

    Ali Rashidi, Lucia Baratto, Ashok Joseph Theruvath, K Elizabeth Hawk & Heike E. Daldrup-Link

  2. Department of Radiology, Pediatric Radiology, Lucile Packard Children’s Hospital, Stanford University School of Medicine, Stanford, CA, USA

    Elton Benjamin Greene

  3. Quantitative Sciences Unit, School of Medicine, Stanford University, Stanford, CA, USA

    Rong Lu

  4. Department of Pediatrics, Hematology/Oncology, Stanford University School of Medicine, Stanford, CA, USA

    Michael P. Link, Sheri L. Spunt & Heike E. Daldrup-Link

  5. Department of Radiology, Lucile Packard Children’s Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA, 94305-5654, USA

    Heike E. Daldrup-Link

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  1. Ali Rashidi
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Corresponding author

Correspondence to Heike E. Daldrup-Link.

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Guarantor

The scientific guarantor of this publication is Dr. Heike E. Daldrup-Link.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr. Rong Lu (Stanford University School of Medicine) has significant statistical expertise.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained (IRB20221 and IRB44706).

Methodology

• prospective

• cross-sectional study

• performed at one institution

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Rashidi, A., Baratto, L., Theruvath, A.J. et al. Diagnostic Accuracy of 2-[18F]FDG-PET and whole-body DW-MRI for the detection of bone marrow metastases in children and young adults. Eur Radiol 32, 4967–4979 (2022). https://doi.org/10.1007/s00330-021-08529-x

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