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A 20 year old female patient diagnosed as Non-Hodgkin lymphoma. MRI was done before onset of therapy. a-d: a Axial T1 WI, b axial T2 WI, c axial DWI and d ADC map show anterior mediastinal mass isointense on T1 WI, heterogeneous hyperintense on T2 WI, hyperintense on DWI and hypointense on ADC map denoting restricted diffusion with ADC mean value 0.641 × 10 −3 mm 2 /s
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Background
Malignant lymphoma accounts for nearly 20% of all mediastinal neoplasms in adults and 50% in children. Hodgkin’s disease is the most common primary mediastinal lymphoma. In non-Hodgkin’s lymphoma, the two most common forms of primary mediastinal lymphoma are lymphoblastic lymphoma and diffuse large B-cell lymphoma. The aim of this study...
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Citations
... Furthermore, it provides more information about cardiac function, overcoming limitations observed with echocardiography, particularly in visualizing the right ventricle. CMR can differentiate benign or malignant cardiac mass by contrast enhancement sequences and is instrumental in evaluating surrounding tissue such as the mediastinum, lung, and coronary arteries involvement [13][14][15]. In this case, left and right ventricle myocardial ...
Introduction: Cardiac involvement, particularly myocardial infiltration in primary mediastinal lymphoma, is a rare occurrence with an incidence of only 9% in known cases of primary malignancy. Neoplasm infiltration into the myocardium manifests through direct invasion, hematogenous spread, transvenous invasion through the great veins, or lymphangitic spreading in the mediastinal. Myocardial infiltration in lymphoma presents a grim prognosis and its treatment may be associated with specific risks, such as myocardial rupture. Various imaging modalities may detect cardiac involvement, with cardiac magnetic resonance (CMR) imaging considered the gold standard. CMR enables clear delineation of myocardial infiltration, making it valuable for local staging, pretreatment planning, and evaluating treatment response. Case Presentation: : A 37-year-old woman patient was diagnosed with primary mediastinal large B-cell lymphoma. Mild chest discomfort and shortness of breath were observed 3 months before hospital admission. A thorax CT scan showed a heterogeneous contrast-enhancing mass with a central necrotic area in the anterior mediastinum. Following thoracotomy and tumor debulking, the patient complained of severe crushing chest pain radiating to her back, accompanied by new T wave inversion on ECG and elevated cardiac troponin levels a week after surgery. Coronary angiogram results showed a normal coronary artery. Subsequent cardiac MRI showed tumor infiltration into the anterior pericardial space, as well as the myocardium of the left and right ventricles. Chemotherapy was promptly initiated, resulting in a gradual improvement of symptoms. Conclusions: In this study, we discuss the use of 3D-CRT in the re-irradiation of NPC with its limitation on obtaining optimum dose sculpture compared to more sophisticated and widely spread modalities like IMRT. However, with careful planning, we can still obtain optimum tumor dose, minimize OAR dose, and subsequently late toxicities that come after. We hope that this study can bring hope to centers with limited facilities, and we suggest further studies on reirradiation, especially in OAR dose tolerance guidelines.
... In some studies about mediastinal lymph nodes, ADC values were found to be significantly lower in lymphoma than in sarcoidosis (26,27). Differentiation of lymphoma subgroups (NHL, HL) could not be achieved in most studies (14,28,29). In these studies, only mean, min and max ADC values were obtained without HA. ...
Aim: Lymphadenopathy (LAP) is one of the most common daily practice clinical findings in children. LAPs that involve more than one region and do not decrease with treatment are a significant cause of anxiety for clinicians and families. In this occurence, ultrasonography, which is the primary imaging method, is insufficient in some cases. Our aim is to make histopathological predictions with apparent diffusion coefficient (ADC) histogram analysis. Material and Method: A total of thirty-one patients, seventeen male and fourteen female, who underwent magnetic resonance imaging and were diagnosed histopathologically (with tru-cut or excisional biopsy) were included in our study. Magnetic resonance imagings were evaluated retrospectively. Results: We could not differentiate lymphoma (when considered as a single group), granulomatous LAP and reactive lymphoid hyperplasia with an ADC histogram analysis (p>0.05). However, when the lymphoma subgroups were evaluated separately, we could only distinguish Burkitt’s lymphoma (with ADCmin values) from other pathologies (p
... In some studies about mediastinal lymph nodes, ADC values were found to be significantly lower in lymphoma than in sarcoidosis (26,27). Differentiation of lymphoma subgroups (NHL, HL) could not be achieved in most studies (14,28,29). In these studies, only mean, min and max ADC values were obtained without HA. ...
... The border line values in this study were seen in neurogenic tumours (n=8; 16.7%) with a mean ADC value of 1.05 ±0.23x10 -3 mm 2 /sec. This agrees with the study conducted by Sabri YY et al., [13] for assessment of diffusion in mediastinal masses, they found that the mean ADC value for neurogenic tumours is (1.08 ±0.32) x -3 mm 2 /sec. ...
... The ADC value of lymphoma was slightly lower than other metastatic lymph nodes in our study, but it was not statistically significant. Furthermore, no significant difference was seen in ADC values of lymph nodes of Hodgkin and non-Hodgkin lymphoma in the current study, while Sabri YY et al. reported significant differences in the ADC value of Hodgkin and non-Hodgkin lymphoma patients in a previous study conducted with 32 subjects [32]. These observations perhaps need further validation with more studies with a larger sample size. ...
Background:
To assess the diagnostic performance of diffusion-weighted (DW) magnetic resonance imaging (MRI) in the characterization of mediastinal lymph nodes and compare them with morphological parameters.
Methods:
A total of 43 untreated patients with mediastinal lymphadenopathy underwent DW and T2 weighted MRI followed by pathological examination in the period from January 2015 to June 2016. The presence of diffusion restriction, apparent diffusion coefficient (ADC) value, short axis dimensions (SAD), and T2 heterogeneous signal intensity of the lymph nodes were evaluated using receiver operating characteristic curve (ROC) and forward step-wise multivariate logistic regression analysis.
Results:
The ADC of malignant lymphadenopathy was significantly lower (0.873 ± 0.109 × 10-3 mm2/s) than that of benign lymphadenopathy (1.663 ± 0.311 × 10-3 mm2/s) (p = 0.001). When an ADC of 1.0955 × 10-3 mm2/s was used as a threshold value for differentiating malignant from benign nodes, the best results were obtained with a sensitivity of 94%, a specificity of 96%, and an area under the curve (AUC) of 0.996. A model combining the other three MRI criteria showed less sensitivity (88.9%) and specificity (92%) compared to the ADC-only model.
Conclusion:
The ADC was the strongest independent predictor of malignancy. The addition of other parameters failed to show any increase in sensitivity and specificity.
... Using ADC, IVIM-DKI, and PET parameters, the characterization of NHL and HL was investigated in this study. ADC was lower in NHL lymph nodes than in HL, and similar results were obtained in previous literature [2,43]. The low cellularity in the DLBCL might be contributing to the low ADC value in NHL. ...
To investigate IVIM-DKI in diagnosing benign and malignant lymph nodes in lymphoma and its subtypes in comparison to FDG-PET/CT. A total of twenty-one (n = 21) patients diagnosed with biopsy-proven Hodgkin lymphoma(HL: n = 13) and non-Hodgkin lymphoma (NHL: n = 8) were prospectively evaluated. All patients underwent MRI(T1-weighted, Short-Tau-Inversion-Recovery (STIR)), and IVIM-DKI was acquired with 9b-values (0–2000s/mm2) at 1.5T and whole-body FDG-PET/CT. The maximum and average standard uptake values (SUVmax and SUVmean) were calculated using PET images. IVIM-DKI parameters (diffusion coefficient(D), pseudo-diffusion coefficient (D*), perfusion fraction (f), and kurtosis (k)) were estimated using IVIM-DKI model with total variation (TV) method (IDTV model). Area-under-curve from receiver-operating-curve (ROC) analysis was used to examine diagnostic value of IVIM-DKI parameters in differentiation between benign and malignant lymph nodes and HL from NHL. Machine learning-based classification of histogram features were performed using linear classifier model. For malignant vs. benign lymph nodes, apparent diffusion coefficient (ADC), f, and k were significantly (p < 0.05) lower in malignant vs. benign lymph nodes. f (AUC:0.88) and k (AUC:0.83) showed high AUC and histogram features combination of f (variance + skewness + kurtosis) showed highest accuracy of 97.2% and AUC of 1. ADC, D, D*, and f were significantly (p < 0.05) lower in NHL than HL. D* showed highest AUC of 0.85 than D (AUC:0.84), ADC (AUC:0.84), and f (AUC:0.74) in NHL vs. HL. SUVmax (spearman-rho = 0.85), ADC (spearman-rho = 0.50), D (spearman-rho = 0.48), and D* (spearman-rho = 0.49) showed significant (p < 0.05) positive correlation with SUVmean. Multi-b-values IVIM-DKI with histogram analysis helps characterize benign and malignant lymph nodes in lymphomas. IVIM-DKI parameters can differentiate malignant lymph nodes in HL and NHL superior to PET parameters
... To our knowledge, only a previous study focused on the role of DW-MRI in the evaluation of the specific group of mediastinal lymphomas, asserting that DWI is a valid and promising technique for the diagnosis and therapy response assessments in these patients [46]. This trial included only two cases with a residual mediastinal mass after treatment, and unlike our study it did not evaluate the tissue metabolic activity by 18 F-FDG PET/CT [46]. ...
... To our knowledge, only a previous study focused on the role of DW-MRI in the evaluation of the specific group of mediastinal lymphomas, asserting that DWI is a valid and promising technique for the diagnosis and therapy response assessments in these patients [46]. This trial included only two cases with a residual mediastinal mass after treatment, and unlike our study it did not evaluate the tissue metabolic activity by 18 F-FDG PET/CT [46]. ...
Background
The persistence of residual tissue after treatment is frequent in patients with mediastinal lymphomas and it is often characterized by ¹⁸ F-Flurodeoxyglucose Positron Emission Tomography ( ¹⁸ F-FDG PET) uptake. This study aims to investigate the usefulness of diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) sequence in residual tissues of treated mediastinal lymphomas and to compare it with ¹⁸ F-FDG PET-CT.
Results
We included 21 patients with mediastinal Hodgkin and non-Hodgkin lymphomas who showed residual masses on PET-CT imaging at end of treatment and underwent DWIBS-Magnetic Resonance Imaging (MRI). SUV max and Apparent Diffusion Coefficient (ADC) values of residual masses were assessed quantitatively, including measurement of mean ADC. 15 patients showed radiotracer uptake at ¹⁸ F-FDG PET-CT, among them only 3 had positive DWIBS-MRI with low ADC values (median value: 0.90 mm ² /s). The mediastinal biopsy in these 3 “double positive” patients confirmed pathological residual tissue. All the patients with positive ¹⁸ F-FDG PET-CT but negative DWIBS-MRI ( n = 18) with high ADC values (median value: 2.05 mm ² /s) were confirmed negative by biopsy.
Conclusions
DWIBS-MRI examination combined with ADC measurement allowed to discriminate pathological and non-pathological residual tissue in patients with treated mediastinal lymphoma. These preliminary results seem to pave the way for a leading role of the MRI which could be a useful alternative to the ¹⁸ F-FDG PET/CT.
Purpose
This study aimed to assess the applicability of the apparent diffusion coefficient (ADC) for differentiating nasopharyngeal carcinoma (NPC) from lymphomas in the head and neck region.
Material and methods
Four databases, including PubMed, the Cochrane Library, EMBASE, and Web of Science, were searched systematically to find relevant literature. The search date was updated to 8 September 2022, with no starting time restriction. The methodological quality of the studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Firstly, a random-effects model was used in a meta-analysis of continuous variables with low heterogeneity to determine the overall effect size, which was reported as the standard mean difference (SMD). Then, bivariate random effects modelling was used to calculate the combined sensitivity and specificity. The area under the curve (AUC) for each diffusion parameter was calculated after constructing summary receiver operating characteristic curves. The presence of heterogeneity was evaluated using subgroup and meta-regression analysis.
Results
Twelve studies involving 181 lymphoma and 449 NPC lesions (N = 630) in the head and neck region were included, of which 5 studies provided sufficient data for pooling diagnostic test accuracy. A meta-analysis of the 12 studies using a random-effects model yielded an SMD of 1.03 (CI = 0.76-1.30; p = 0.00001), implying that NPC lesions had a significantly higher ADC value than lymphoma lesions. By pooling 5 standard DWI studies, the pooled sensitivity and specificity of ADC were 0.90 (95% CI: 0.82-0.95) and 0.63 (95% CI: 0.52-0.72), respectively. The area under the curve (AUC) calculated from the SROC curve was 0.74 (95% CI: 0.70-0.78).
Conclusions
According to this systematic review and meta-analysis, nasopharyngeal carcinoma has a significantly higher ADC value than lymphomas. Furthermore, while ADC has excellent sensitivity for distinguishing these 2 types of tumours, its specificity is relatively low, yielding a moderate diagnostic performance. Further investigations with larger sample sizes are required.
