A ressonância magnética de corpo inteiro no diagnóstico de metástases em crianças e adolescentes: uma revisão sistemática e meta-análise

Valduga, Simone Gianella; Forte, Gabriele Carra; Paganin, Ricardo Pessini; Abreu, Diego Gomez; Medeiros, Tássia Machado; Irion, Klaus; Hochhegger, Bruno; Mattiello, Rita

doi:10.1590/0100-3984.2020.0183

Simone Gianella Valduga

Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.

https://orcid.org/0000-0001-9167-7284

Gabriele Carra Forte Correspondence: Gabriele Carra Forte. Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS). Avenida Ipiranga, 6690, 1º andar, Petrópolis. Porto Alegre, RS, Brazil, 90610-000. Email: gabicarraforte@yahoo.com.br.

Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.

https://orcid.org/0000-0002-1480-8196

Ricardo Pessini Paganin

Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.

https://orcid.org/0000-0002-7156-0895

Diego Gomez Abreu

Universidad Industrial de Santander (UIS), Bucaramanga, Santander, Colombia.

https://orcid.org/0000-0002-4303-5225

Tássia Machado Medeiros

Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.

https://orcid.org/0000-0002-0536-2110

Klaus Irion

Thoracic Imaging DIIRM, Manchester University and Manchester University NHS Foundation Trust Department of Radiology, Manchester, UK.

https://orcid.org/0000-0002-7860-7879

Bruno Hochhegger

Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.

https://orcid.org/0000-0003-1984-4636

Rita Mattiello

Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.

https://orcid.org/0000-0002-0548-3342

Correspondence: Gabriele Carra Forte. Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS). Avenida Ipiranga, 6690, 1º andar, Petrópolis. Porto Alegre, RS, Brazil, 90610-000. Email: gabicarraforte@yahoo.com.br.

Authors	Study design	Population	Inclusion criterion	Index test	Blind	WB-MRI parameters	PET/CT parameters	Confirmed (n)
Kumar et al.⁽¹⁴14 Kumar J, Seith A, Kumar A, et al. Whole-body MR imaging with the use of parallel imaging for detection of skeletal metastases in pediatric patients with small-cell neoplasms: comparison with skeletal scintigraphy and FDG PET/CT. Pediatr Radiol. 2008;38:953-62.⁾	Cross-sectional	N = 26; 62% males; age range, 0.58-18 years	Small-cell neoplasm	Yes	Yes	1.5 T, STIR, T1W	5,254 MBq/kg, 45 min^* * Administration time.	26
Punwani et al.⁽¹⁵15 Punwani S, Taylor SA, Bainbridge A, et al. Pediatric and adolescent lymphoma: comparison of whole-body STIR half-Fourier RARE MR imaging with an enhanced PET/CT reference for initial staging. Radiology. 2010;255:182-90.⁾	Cross-sectional	N = 29; 62% males; age range, 5-20 years	Lymphoma (26 Hodgkin and 3 non-Hodgkin)	Yes	Yes	1.5 T, STIR, RARE	5,254 MBq/kg, 60 min^* * Administration time.	29
Ishiguchi et al.⁽¹⁶16 Ishiguchi H, Ito S, Kato K, et al. Diagnostic performance of 18F-FDG PET/CT and whole-body diffusion-weighted imaging with background body suppression (DWIBS) in detection of lymph node and bone metastases from pediatric neuroblastoma. Ann Nucl Med. 2018;32:348-62.⁾	Cross-sectional	N = 13; 54% males; mean age, 2.9 ± 2.0 years	Neuroblastoma	Yes	Yes	1.5 T, STIR, DWIBS	3.7 MBq/kg, 50 min^* * Administration time.	13
Daldrup-Link et al.⁽⁸8 Daldrup-Link HE, Franzius C, Link TM, et al. Whole-body MR imaging for detection of bone metastases in children and young adults: comparison with skeletal scintigraphy and FDG PET. AJR Am J Roentgenol. 2001;177:229-36.⁾	Cross-sectional	N = 39; 69% males; age range, 2-19 years	Primary tumor with potential to metastasize to bone	Yes	Yes	1.5 T, STIR, T1W	3.7 MBq/kg, 60 min^* * Administration time.	39
Littooij et al.⁽¹⁷17 Littooij AS, Kwee TC, Barber I, et al. Whole-body MRI for initial staging of paediatric lymphoma: prospective comparison to an FDG-PET/CT-based reference standard. Eur Radiol. 2014;24:1153-65.⁾	Cross-sectional	N = 33; 61% males; age range, 6-21 years	Lymphoma	Yes	Yes	1.5 T, STIR, T1W, DWIBS	5.18-7.4 MBq/kg, 60 min^* * Administration time.	33
Latifoltojar et al.⁽¹⁸18 Latifoltojar A, Punwani S, Lopes A, et al. Whole-body MRI for staging and interim response monitoring in paediatric and adolescent Hodgkin's lymphoma: a comparison with multi-modality reference standard including 18F-FDG-PET-CT. Eur Radiol. 2019;29:202-12.⁾	Cross-sectional	N = 50; 64% males; age range, 5-20 years	Hodgkin lymphoma	Yes	Yes	1.5 T, STIR, T1W FLASH, DWIBS	3.7 MBq/kg, 60 min^* * Administration time.	50

Authors	Test interpretation
Kumar et al.⁽¹⁴14 Kumar J, Seith A, Kumar A, et al. Whole-body MR imaging with the use of parallel imaging for detection of skeletal metastases in pediatric patients with small-cell neoplasms: comparison with skeletal scintigraphy and FDG PET/CT. Pediatr Radiol. 2008;38:953-62.⁾	For each patient, metastases were recorded according to body region. The body was divided into eight regions for the purpose of localization of metastases. On turbo STIR images, skeletal metastases were defined as focal or diffuse hyperintensity of marrow, greater than or equal to the signal intensity of cerebrospinal fluid. On T1-weighted images, marrow metastases were defined as areas of hypointensity, less than or equal to the signal intensity of skeletal muscle. With systemic sclerosis or on FDG-PET, metastatic disease was defined as a focal area of increased radionuclide uptake relative to adjacent and/or contralateral normal tissue.
Punwani et al.⁽¹⁵15 Punwani S, Taylor SA, Bainbridge A, et al. Pediatric and adolescent lymphoma: comparison of whole-body STIR half-Fourier RARE MR imaging with an enhanced PET/CT reference for initial staging. Radiology. 2010;255:182-90.⁾	MRI: The body was divided into 11 nodal areas by standard anatomic definitions. Disease positivity was defined as a mass with a shortaxis dimension greater than 1 cm. PET/TC: Disease positivity was defined as the presence of lymph nodes with focal FDG uptake greater than that of the background.
Ishiguchi et al.⁽¹⁶16 Ishiguchi H, Ito S, Kato K, et al. Diagnostic performance of 18F-FDG PET/CT and whole-body diffusion-weighted imaging with background body suppression (DWIBS) in detection of lymph node and bone metastases from pediatric neuroblastoma. Ann Nucl Med. 2018;32:348-62.⁾	The presence of lymph node metastasis was assessed in eight regions. Bone metastasis was investigated in 17 bone segments. On whole-body DWIBS, the signal intensity of skeletal muscles was used as the reference standard for the judgment of positive results. On ¹⁸F-FDG PET/CT, ¹²³I-metaiodobenzylguanidine scintigraphy/single-photon-emission CT/CT, and bone scintigraphy/single-photon- emission CT, the loci where uptake was visibly higher than the activity of adjacent areas were considered uptake-positive. On CT, characteristic massive lesions corresponding to the sites of lymph nodes were defined as metastasis-positive findings, as were focal or diffuse skeletal lesions with or without deformity of cortical bone.
Daldrup-Link et al.⁽⁸8 Daldrup-Link HE, Franzius C, Link TM, et al. Whole-body MR imaging for detection of bone metastases in children and young adults: comparison with skeletal scintigraphy and FDG PET. AJR Am J Roentgenol. 2001;177:229-36.⁾	For all imaging modalities, lesion number and location were determined. On T1-weighted spin-echo images, a metastatic bone or bone marrow lesion was defined as focal or diffuse hypointense bone marrow signal intensity relative to adjacent normal bone marrow. In patients over 10 years of age, neoplastic marrow was defined as that with a signal that was hypointense or isointense in relation to the adjacent muscle tissue. FDG-PET: a metastatic bone lesion was defined as a focal area of increased radionuclide uptake relative to the adjacent and contralateral normal tissue.
Littooij et al.⁽¹⁷17 Littooij AS, Kwee TC, Barber I, et al. Whole-body MRI for initial staging of paediatric lymphoma: prospective comparison to an FDG-PET/CT-based reference standard. Eur Radiol. 2014;24:1153-65.⁾	Nodal regions included cervical (including supraclavicular nodal site), axillary, infraclavicular, mediastinal, hilar, para-aortic, mesenteric, pelvic and inguinal lymph node regions. Lymph nodes were considered positive for lymphomatous involvement if their short-axis diameter exceeded 10 mm on coronal T1- and T2-weighted STIR images. Extranodal sites included the thymus, pleura, lung, spleen, liver, kidney, bowel, bone marrow, and soft tissues. Diffusion-weighted imaging was used in order to detect potentially involved nodal and extranodal sites.
Latifoltojar et al.⁽¹⁸18 Latifoltojar A, Punwani S, Lopes A, et al. Whole-body MRI for staging and interim response monitoring in paediatric and adolescent Hodgkin's lymphoma: a comparison with multi-modality reference standard including 18F-FDG-PET-CT. Eur Radiol. 2019;29:202-12.⁾	MRI: The disease status for the same 18 nodal disease sites and 14 extranodal disease sites. The ADC was measured by placing a region of interest in the largest cross-section of the node on the ADC map, guided by anatomically matched axial fat-suppressed T2-weighted MRI. PET/TC: Definitions of nodal disease based on long-axis size and FDG uptake in comparison with background activity.

[1] Correspondence: Gabriele Carra Forte. Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS). Avenida Ipiranga, 6690, 1º andar, Petrópolis. Porto Alegre, RS, Brazil, 90610-000. Email: gabicarraforte@yahoo.com.br.

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A ressonância magnética de corpo inteiro no diagnóstico de metástases em crianças e adolescentes: uma revisão sistemática e meta-análise

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