Whole-body magnetic resonance imaging provides accurate staging of diffuse large B-cell lymphoma, but is less preferred by patients

Table 1 Whole-body magnetic resonance imaging sequences

Sequence	Orientation	Resp	Slice thickness (mm)	Slice gap (mm)	Slices (n)	TE (millisecond)	TR (millisecond)	Time (minute: second)	Stations (n)
DWIBS	Axial	No	6.0	1.0	43	58	8400	3:13	4
T2	Coronal	No	5.0	1.0	54	80	1300	1:08	3
T2 STIR	Coronal	No	5.0	1.0	54	70	14100	0:57	3
T1 DCE	Axial	4D-FB	4.0	-2.0	185	1.3	3.3	5:50	1
T1 DIXON	Axial	BH	4.0	-2.0	137	1.3	3.5	0:15	4

Resp: Respiratory compensation; DCE: Dynamic contrast enhancement; 4D-FB: Four dimensions free breathing; BH: Breath-hold (expiratory); TE: Echo time; TR: Repetition time; DWIBS: Diffusion weighted images with background suppression; STIR: Short tau inversion recovery.

Table 2 Patient characteristics, mean ± SD/n (%)

Variable	Value
n	14
Age (years)	62.7 ± 12.1
Male gender	7 (50)
Clinical stage III–IV	11 (79)
Extranodal involvement of ≥ 2 sites	10 (71)
PS ECOG ≥ 2	4 (29)
Elevated serum lactate dehydrogenase	7 (50)
International prognostic index 3-5	9 (64)
Time between PET/CT and wbMRI (days)	3 (IQR: 1-4)

wbMRI: Whole-body magnetic resonance imaging; PET/CT: Positron emission tomography/computed tomography; PS ECOG: Performance status according to Eastern Cooperative Oncology Group; IQR: Interquartile range.

Table 3 Whole body magnetic resonance imaging and fluorodeoxyglucose positron emission tomography/computed tomography results

	wbMRI, n	PET/CT, n	TP, n	FP, n	TN, n	FN, n	Senz.	Spec.	PPV	NPV	Acc
Nodal
Waldeyer ring	1	1	1	0	13	0	1.00	1.00	1.00	1.00	1.00
Cervical and supraclavicular	3	3	3	0	11	0	1.00	1.00	1.00	1.00	1.00
Axillary (R)	1	1	1	0	13	0	1.00	1.00	1.00	1.00	1.00
Axillary (L)	1	2	1	0	12	1	0.50	1.00	1.00	0.92	0.93
Mediastinal and hilar	1	1	1	0	13	0	1.00	1.00	1.00	1.00	1.00
Epigastric	3	3	3	0	11	0	1.00	1.00	1.00	1.00	1.00
Mesenteric	4	4	4	0	10	0	1.00	1.00	1.00	1.00	1.00
Retroperitoneal	4	5	4	0	9	1	0.80	1.00	1.00	0.90	0.93
Iliac and pelvic (R)	3	4	3	0	10	1	0.75	1.00	1.00	0.91	0.93
Iliac and pelvic (L)	3	4	3	0	10	1	0.75	1.00	1.00	0.91	0.93
Inguinal (R)	2	2	1	1	11	1	0.50	0.92	0.50	0.92	0.86
Inguinal (L)	1	1	1	0	13	0	1.00	1.00	1.00	1.00	1.00
Spleen	1	1	1	0	13	0	1.00	1.00	1.00	1.00	1.00
Lymphatic overall	27	32	27	1	149	5	0.84	0.99	0.96	0.97	0.97
Extranodal1
Bone	5	5	5	0	9	0	1.00	1.00	1.00	1.00	1.00
Bone marrow	4	4	4	0	10	0	1.00	1.00	1.00	1.00	1.00
Soft tissue	4	4	4	0	10	0	1.00	1.00	1.00	1.00	1.00
Lung	1	1	1	0	13	0	1.00	1.00	1.00	1.00	1.00
Pleura	1	1	1	0	13	0	1.00	1.00	1.00	1.00	1.00

¹Multifocal involvement of one system in a patient reported as single finding.

wbMRI: Whole-body magnetic resonance imaging; PET/CT: Positron emission tomography/computed tomography; TP: True positive; FP: False positive; TN: True negative; FN: False negative; Senz: Sensitivity; Spec: Specificity; Acc: Accuracy; PPV: Positive predictive value; NPV: Negative predictive value; R: Right; L: Left.

Table 4 Comparison of negative and positive lymph nodes by their long axis and short axis diameters and derived values (product and ratio of long axis and short axis), presence of fatty hilum, and signal intensity on diffusion weighted images with background suppression

	Negative LN regions (n = 127) median (IQR)	Positive LN regions (n = 27) median (IQR)	P value	AUC (95%CI)	P value
Long axis (mm)	17 (12-21)	28 (22-36)	< 0.0001	0.87 (0.80 to 0.95)	< 0.0001
Short axis (mm)	7 (6-8)	14 (10-25)	< 0.0001	0.87 (0.79 to 0.96)	< 0.0001
LA × SA (mm × mm)	120 (72-161)	420 (210-936)	< 0.0001	0.89 (0.81 to 0.97)	< 0.0001
LA: SA	2.3 (1.8-2.8)	1.8 (1.5-2.3)	0.0039	0.68 (0.56 to 0.81)	0.0032
Fatty hilum (0-3)1	1 (0.0-2.3)	0 (0-1)	0.0015	0.69 (0.58 to 0.79)	0.0023
DWIBS (0-3)	2 (2-3)	3 (3-3)	< 0.0001	0.71 (0.62 to 0.80)	0.00059

¹Fatty hilum: 0: Absent and 3: Present.

LN: Lymph node; LA: Long axis; SA: Short axis; DWIBS: Diffusion weighted imaging with background suppression; AUC: Area under curve; IQR: Interquartile range; CI: Confidence interval.