Huang W-Y, Wen J-B, Wu G, Yin B, Li J-J, Geng D-Y
From the Departments of Radiology (W.-Y.H., J.-J.L.).
Department of Radiology (J.-B.W., B.Y., D.-Y.G.), Huashan Hospital, Fudan University, Shanghai, China.
AJNR Am J Neuroradiol. 2016 Nov;37(11):2010-2018. doi: 10.3174/ajnr.A4867. Epub 2016 Jul 7.
Whether ADC value predicts the therapy response and outcomes of primary central system lymphoma remains controversial. This study assessed the minimum ADC correlated with treatment response in patients with primary central nervous system lymphoma undergoing methotrexate-based chemotherapy.
Thirty-five patients with primary central nervous system lymphoma underwent conventional MR imaging and DWI before chemotherapy and after 1 and 5 cycles of chemotherapy. Treatment response was determined according to the International PCNSL Collaborative Group criteria and was classified as a complete response, partial response, or progressive disease. Pretreatment minimum ADC, minimum ADC after 1 cycle, minimum ADC after 5 cycles, and change in minimum ADC were compared among the different response groups. The Pearson correlation test was calculated between these ADC parameters and tumor response.
The pretreatment minimum ADC of the progressive disease group was lower than that of the complete response and partial response groups, but there was no significant difference among them. The minimum ADC after 1 cycle and minimum ADC after 5 cycles were statistically significantly higher than the pretreatment minimum ADC. A comparison among groups showed that minimum ADC after 1 cycle, minimum ADC after 5 cycles, minimum ADC change, and the percentage of minimum ADC change were all significantly different among the 3 groups. A significant positive correlation was observed between the percentage of minimum ADC after 1 cycle of chemotherapy and the size reduction percentage after 5 cycles of chemotherapy. The minimum ADC change and the percentage of minimum ADC change performed better in the differentiation of the final treatment response, specifically in complete response and partial response from progressive disease.
The minimum ADC after 1 cycle and minimum ADC changes were better correlated with the treatment response than the pretreatment minimum ADC. Minimum ADC after early therapy may potentially to be used to predict and monitor the response of primary central nervous system lymphoma to chemotherapy.
表观扩散系数（ADC）值能否预测原发性中枢系统淋巴瘤的治疗反应及预后仍存在争议。本研究评估了接受基于甲氨蝶呤化疗的原发性中枢神经系统淋巴瘤患者中与治疗反应相关的最低ADC值。
35例原发性中枢神经系统淋巴瘤患者在化疗前、化疗1个周期后及5个周期后接受了常规磁共振成像（MRI）及扩散加权成像（DWI）检查。根据国际原发性中枢神经系统淋巴瘤协作组标准确定治疗反应，并分为完全缓解、部分缓解或疾病进展。比较不同反应组之间的治疗前最低ADC值、1个周期后最低ADC值、5个周期后最低ADC值以及最低ADC值的变化。计算这些ADC参数与肿瘤反应之间的Pearson相关性检验。
疾病进展组的治疗前最低ADC值低于完全缓解组和部分缓解组，但两组之间无显著差异。1个周期后最低ADC值和5个周期后最低ADC值在统计学上显著高于治疗前最低ADC值。组间比较显示，1个周期后最低ADC值、5个周期后最低ADC值、最低ADC值变化及最低ADC值变化百分比在三组之间均有显著差异。化疗1个周期后最低ADC值百分比与化疗5个周期后肿瘤缩小百分比之间存在显著正相关。最低ADC值变化及最低ADC值变化百分比在区分最终治疗反应方面表现更好，特别是在区分完全缓解和部分缓解与疾病进展方面。
与治疗前最低ADC值相比，1个周期后最低ADC值及最低ADC值变化与治疗反应的相关性更好。早期治疗后的最低ADC值可能潜在地用于预测和监测原发性中枢神经系统淋巴瘤对化疗的反应。
