Siegel Marilyn J, Jokerst Clint E, Rajderkar Dhana, Hildebolt Charles F, Goyal Sagun, Dehdashti Farrokh, Wagner Johnston Nina, Siegel Barry A
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
NMR Biomed. 2014 Jun;27(6):681-91. doi: 10.1002/nbm.3105. Epub 2014 Apr 3.
The aim of this study was to compare diffusion-weighted MRI (DW-MRI) with positron emission tomography/computed tomography (PET/CT) for the staging and evaluation of the treatment response in patients with diffuse large B-cell lymphoma (DLBCL). Institutional review board approval was obtained for this study; all subjects gave informed consent. Twelve patients were imaged before treatment and eight of these were also imaged after two cycles of chemotherapy using both DW-MRI and PET/CT. Up to six target lesions were selected at baseline for response assessment based on International Working Group criteria (nodes > 1.5 cm in diameter; extranodal lesions > 1 cm in diameter). For pretreatment staging, visual analysis of the numbers of nodal and extranodal lesions based on PET/CT was performed. For interim response assessment after cycle 2 of chemotherapy, residual tumor sites were assessed visually and the percentage changes in target lesion size, maximum standardized uptake value (SUVmax ) and apparent diffusion coefficient (ADC) from pretreatment values were calculated. In 12 patients studied pretreatment, there were 46 nodal and 16 extranodal sites of lymphomatous involvement. Agreement between DW-MRI and PET/CT for overall lesion detection was 97% (60/62 tumor sites; 44/46 nodal and 16/16 extranodal lesions) and, for Ann Arbor stage, it was 100%. In the eight patients who had interim assessment, five of their 49 tumor sites remained abnormal on visual analysis of both DW-MRI and PET/CT, and there was one false positive on DW-MRI. Of their 24 target lesions, the mean pretreatment ADC value, tumor size and SUVmax were 772 µm(2) /s, 21.3 cm(2) and 16.9 g/mL, respectively. At interim assessment of the same 24 target lesions, ADC values increased by 85%, tumor size decreased by 74% and SUVmax decreased by 83% (all p < 0.01 versus baseline). DW-MRI provides results comparable with those of PET/CT for staging and early response assessment in patients with DLBCL.
本研究旨在比较弥散加权磁共振成像（DW-MRI）与正电子发射断层扫描/计算机断层扫描（PET/CT）在弥漫性大B细胞淋巴瘤（DLBCL）患者分期及治疗反应评估中的应用。本研究获得了机构审查委员会的批准；所有受试者均签署了知情同意书。12例患者在治疗前进行了成像检查，其中8例在接受两个周期化疗后同时使用DW-MRI和PET/CT进行了成像检查。根据国际工作组标准（直径>1.5 cm的淋巴结；直径>1 cm的结外病变），在基线时选择多达6个靶病变进行反应评估。对于治疗前分期，基于PET/CT对淋巴结和结外病变的数量进行视觉分析。对于化疗第2周期后的中期反应评估，对残留肿瘤部位进行视觉评估，并计算靶病变大小、最大标准化摄取值（SUVmax）和表观扩散系数（ADC）相对于治疗前值的百分比变化。在12例接受治疗前研究的患者中，有46个淋巴结和16个结外部位存在淋巴瘤累及。DW-MRI与PET/CT在总体病变检测方面的一致性为97%（62个肿瘤部位中的60个；46个淋巴结中的44个和16个结外病变中的16个），在Ann Arbor分期方面，一致性为100%。在8例进行中期评估的患者中，在对DW-MRI和PET/CT的视觉分析中，其49个肿瘤部位中有5个仍异常，且DW-MRI有1例假阳性。在其24个靶病变中，治疗前ADC值、肿瘤大小和SUVmax的平均值分别为772 µm(2)/s、21.3 cm(2)和16.9 g/mL。在对相同的24个靶病变进行中期评估时，ADC值增加了85%，肿瘤大小减少了74%，SUVmax减少了83%（与基线相比，所有p<0.01）。DW-MRI在DLBCL患者的分期和早期反应评估中提供了与PET/CT相当的结果。
