A meta-analysis on the diagnostic performance of whole-body MRI for the initial staging of Hodgkin lymphoma in children and adults using FDG-PET/CT as a reference standard

Abstract

Background: Staging of Hodgkin lymphoma is important for determining prognosis and treatment planning. The current gold standard is FDG-PET/CT, but WB-MRI could be a radiation free alternative. Objective: A meta-analysis of all published data on the diagnostic performance of WB-MRI for the initial staging of Hodgkin lymphoma using FDG-PET/CT as a reference standard. Evidence Acquisition: Both the PubMed/MEDLINE and EMBASE databases were systematically searched (updated until March 14, 2023) for studies that compared WB-MRI with FDG-PET/CT for staging Hodgkin lymphoma. The “quality assessment of diagnostic accuracy studies” tool (QUADAS-2) was used to assess methodological quality. Pooled staging accuracy, sensitivity and specificity of WB-MRI compared to FDG-PET/CT was calculated for determining stage and for both nodal and extra-nodal staging. A sensitivity analysis for children and adults was performed. Evidence Synthesis: A total of nine studies with a combined total of 297 Hodgkin lymphoma patients were included. Pooled sensitivity and specificity for nodal staging were 94% (95%CI 0.92–0.96) and 99% (95%CI 0.98–1.00) respectively. For extra-nodal staging sensitivity and specificity were 90% (95%CI 0.74–0.96) and 100% (95%CI 0.99–1.00). For disease stage, the pooled accuracy was 92% for pediatric studies (95%CI 0.86–0.96), 94% for adult studies (95%CI 0.87–0.97) and 92% (95%CI 0.87–0.96) for all studies combined. Conclusion: When using FDG-PET/CT as a reference standard, WB-MRI shows high sensitivity and specificity for both nodal and extra-nodal staging and for determining disease stage both in children and adults. Clinical Impact: WB-MRI could be used as a good radiation-free alternative for FDG-PET/CT in Hodgkin lymphoma staging.