Comparison of Nasopharyngeal MR, 18 F-FDG PET/CT, and 18 F-FDG PET/MR for Local Detection of Natural Killer/T-Cell Lymphoma, Nasal Type

The present study aims to compare the diagnostic efficacy of MR, F-FDG PET/CT, and F-FDG PET/MR for the local detection of early-stage extranodal natural killer/T-cell lymphoma, nasal type (ENKTL). Thirty-six patients with histologically proven early-stage ENKTL were enrolled from a phase 2 study (Cohort A). Eight nasopharyngeal anatomical regions from each patient were imaged using F-FDG PET/CT and MR. A further nine patients were prospectively enrolled from a multicenter, phase 3 study; these patients underwent F-FDG PET/CT and PET/MR after a single F-FDG injection (Cohort B). Region-based sensitivity and specificity were calculated. The standardized uptake values (SUV) obtained from PET/CT and PET/MR were compared, and the relationship between the SUV and apparent diffusion coefficients (ADC) of PET/MR were analyzed. In Cohort A, of the 288 anatomic regions, 86 demonstrated lymphoma involvement. All lesions were detected by F-FDG PET/CT, while only 70 were detected by MR. F-FDG PET/CT exhibited a higher sensitivity than MR (100% vs. 81.4%, χ = 17.641, < 0.001) for local detection of malignancies. The specificity of F-FDG PET/CT and MR were 98.5 and 97.5%, respectively (χ = 0.510, = 0.475). The accuracy of F-FDG PET/CT was 99.0% and the accuracy of MR was 92.7% (χ = 14.087, < 0.001). In Cohort B, 72 anatomical regions were analyzed. PET/CT and PET/MR have a sensitivity of 100% and a specificity of 92.5%. The two methods were consistent (κ = 0.833, < 0.001). There was a significant correlation between PET/MR SUVmax and PET/CT SUVmax ( = 0.711, < 0.001), and SUVmean ( = 0.685, < 0.001). No correlation was observed between the SUV and the ADC. In early-stage ENKTL, nasopharyngeal MR showed a lower sensitivity and a similar specificity when compared with F-FDG PET/CT. PET/MR showed similar performance compared with PET/CT.