Whole body magnetic resonance in indolent lymphomas under watchful waiting: The time is now

Abstract

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The indolent non-Hodgkin lymphomas (i-NHLs) are characterised by 'indolent' clinical behaviour with slow growth and prolonged natural history. The watchful waiting (WW) strategy is a frequently employed treatment option in these patients. This implies a strict monitoring by imaging examinations, including 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) and CT. A major concern is radiation exposure due to regularly monitoring by conventional imaging procedures. Several studies have demonstrated the reliability of whole-body magnetic resonance imaging (WB-MRI) for lymphoma staging. WB-MRI could be useful for active surveillance in i-NHLs providing the suspect of disease progression that can be then confirmed by additional diagnostic procedures, including 18F-FDG-PET/CT. The directive 2013/59 by the European Union claims that if a radiation-free imaging technique allows obtaining the same diagnostic results, it should be invariably used. In this setting, WB-MRI may be considered a reasonable option in i-NHLs under WW, replacing imaging modalities that cause exposure to ionising radiations. This will help to reduce the cancer risk in i-NHL patients for whom chemo-/radiotherapy remain the usual treatment options following the usually long WW phase. The scientific community should raise the awareness of the risk of ionising radiations in i-NHLs and the emphasise the need for establishing the proper place of WB-MRI in lymphoma imaging.

Key Points

• Watchful waiting is a reasonable option in patients with indolent non-Hodgkin lymphomas.

• Imaging is crucial to monitor patients with indolent non-Hodgkin lymphomas.

• CT and ¹⁸F-FDG-PET/CT are commonly used, implying a substantial radiation exposure.

• WB-MRI is highly reliable in lymphoma staging.

• WB-MRI may be considered to monitor indolent non-Hodgkin lymphomas under watchful waiting.