Diffusion-weighted MRI of lymphoma: prognostic utility and implications for PET/MRI?

• Published in: European journal of nuclear medicine and molecular imaging 2013-02, Vol.40 (3), p.373-385
• Main Authors: Punwani, Shonit, Taylor, Stuart A., Saad, Ziauddin Z., Bainbridge, Alan, Groves, Ashley, Daw, Stephen, Shankar, Ananth, Halligan, Steve, Humphries, Paul D.
• Format: Article
• Language: English
• Subjects: Adolescent; Biological Transport; Cardiology; Chemotherapy; Child; Decision Trees; Diffusion; Diffusion Magnetic Resonance Imaging; Female; Follow-Up Studies; Hodgkin Disease - diagnosis; Hodgkin Disease - diagnostic imaging; Hodgkin Disease - drug therapy; Hodgkin Disease - pathology; Humans; Imaging; Lymphoma; Male; Medicine; Medicine & Public Health; NMR; Nuclear magnetic resonance; Nuclear Medicine; Oncology; Original Article; Orthopedics; Positron-Emission Tomography; Prognosis; Radiology; Retrospective Studies; Treatment Outcome; Tumor Burden
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-012-2293-7

Purpose With the recent introduction of PET/MRI, we investigated whether diffusion-weighted imaging (DWI) can complement PET for predicting local treatment response in Hodgkin lymphoma. Methods This retrospective study included 39 patients selected from a hospital database with a histological diagnosis of Hodgkin lymphoma undergoing whole-body MRI (supplemented by DWI) and PET/CT before and after two cycles of vincristine, etoposide, prednisolone and doxorubicin (OEPA). The pretreatment volume, MRI apparent diffusion coefficient (ADC) and PET maximum standardized uptake value (SUV max ) of the largest nodal mass were determined quantitatively for evaluation of the local response following two cycles of OEPA. Quantitative pretreatment imaging biomarkers (disease volume, ADC, SUV max ) were compared between sites with an adequate and those with an inadequate response using Fisher’s exact test and Mann Whitney statistics. Multivariate models predictive of an inadequate response based on demographic/clinical features, pretreatment disease volume and SUV max without (model 1) and with (model 2) the addition of ADC were derived and crossvalidated. The ROC area under curve (AUC) was calculated for both models using the full dataset (training) and the crossvalidation (test) data. Results Sites with an adequate response had a significantly lower median pretreatment ADC (1.0 × 10 −3 mm 2 s −1 ) than those with an inadequate response (1.26 × 10 −3 mm 2 s −1 ; p