Nesterova E S, Yatsyk G A, Lutsik N S, Kravchenko S K, Sudarikov A B, Krasil'nikova I V, Gemdzhian E G, Kovrigina A M
National Research Center for Hematology.
Ter Arkh. 2020 Sep 1;92(7):55-62. doi: 10.26442/00403660.2020.07.000774.
This study conducted the possibilities of diffusion-weighted magnetic resonance imaging of the whole body diffusion WB-MRI (in comparison with positron emission tomography with computed tomography PET/CT) in assessing the volume and prevalence of the tumor, as well as determining bone marrow (BM) damage (for various cytological types) in the diagnosis and staging of the disease in patients with FL.
A prospective comparative search study included 15 patients (4 men and 11 women, with a median age of 53 years) with newly diagnosed FL. Patients have not received antitumor chemotherapy previously. After the diagnosis was established, all patients (with the blindness of both the cases themselves and some specialists regarding the results of other specialists) were examined by PET/CT and diffusion WB-MRI, after which a BM examination was performed (histological examination and determination of B-cell clonality in BM puncture by PCR). Using the diffusion WB-MRI method, the prevalence of tumor lesion (nodal and extranodal foci) in each patient was estimated, and the total tumor volume was calculated, BM lesion was detected, and BM lesion volume was calculated. For lesions of different localization, the measured diffusion coefficient (DC) of the diffusion WB-MRI and the standardized rate of accumulation of the radiopharmaceutical in tissues (SUV) of the PET/CT method were determined and compared with each other (for the same areas). Statistical analysis was performed using the estimate of agreement (by Cohens kappa coefficient and asymptotic test) of the results of the compared methods.
Estimates of the prevalence of tumor damage (lymph nodes and extranodal foci) using the diffusion WB-MRI and PET/CT methods were the same. High DC and SUV were observed in the peripheral lymph nodes, extranodal foci and bulky, low DC and SUV in the foci of BM. All 4 methods successfully determined BM damage, however, the diffusion WB-MRI had comparatively less negative results. The highest values of SUV and CD were noted in cases of the 3 grade of FL. Using the diffusion WB-MRI method, the prevalence of tumor lesion was assessed in each patient (nodal and extranodal foci were detected) and the total tumor volume was calculated, BM lesion detection was performed, and the volume of BM lesion was calculated. It is important to note that with the help of diffusion WB-MRI, it was possible to measure separately the total tumor volume (462025 cm3) and separately the volume of bulky (251358 cm3). The diffusion WB-MRI allowed us to differentiate the volume of tumor tissue (reduced as a result of treatment) and residual (fibrous-adipose) tissue in residual formations (which averaged 21% of the initial volume). The predictors of a poor antitumor response were the maximum SUV values (more than 14.0) and the minimum DC values (0.510-3mm2/s) in the BM foci.
The diffusion WB-MRI allows for detailed visualization of BM lesions and surrounding soft tissues both in the debut of the FL and in the process of tracking the effectiveness of chemotherapy, which makes it possible to use it along with PET/CT. Diffusion WB-MRI allows to separately evaluate the volume of true tumor tissue and residual tissue. Cases of the 3 grade of FL (including the transformation of FL into diffuse B-large cell lymphoma) are isolated due to low DC values (and high SUV values) in the tumor tissue. BM foci of FL lesion also have (in comparison with nodal and extranodal foci) lower DC values. The predictors of a poor antitumor response were high (from 14.0 or more) SUV valuesin the tumor (and especially in bulky), and low (about 0.5103mm2/s) DC values of BM foci. The PET/CT and diffusion WB-MRI have proven to be reliable diagnostic tools for establishing the stage of FL and detecting BM damage. Diffusion WB-MRI for FL is an informative first-line diagnostic method that allows regular monitoring of the disease and early detection of foci of relapse and disease progression.
本研究探讨全身扩散加权磁共振成像（WB-MRI）（与正电子发射断层扫描/计算机断层扫描PET/CT相比）在评估滤泡性淋巴瘤（FL）患者疾病诊断和分期中肿瘤体积及患病率，以及确定骨髓（BM）损伤（针对各种细胞学类型）的可能性。
一项前瞻性对比研究纳入了15例新诊断的FL患者（4例男性和11例女性，中位年龄53岁）。患者此前未接受过抗肿瘤化疗。确诊后，所有患者（患者自身及部分专家对其他专家的结果均不知情）接受了PET/CT和扩散WB-MRI检查，之后进行了BM检查（组织学检查及通过聚合酶链反应测定BM穿刺中的B细胞克隆性）。使用扩散WB-MRI方法，评估了每位患者肿瘤病变（淋巴结和结外病灶）的患病率，计算了肿瘤总体积，检测了BM病变并计算了BM病变体积。对于不同部位的病变，测定了扩散WB-MRI的测量扩散系数（DC）和PET/CT方法中组织内放射性药物的标准化摄取率（SUV），并相互比较（针对相同区域）。采用一致性估计（通过科恩斯kappa系数和渐近检验）对比较方法的结果进行统计分析。
使用扩散WB-MRI和PET/CT方法对肿瘤损伤（淋巴结和结外病灶）患病率的估计相同。外周淋巴结、结外病灶和体积较大的病灶中观察到高DC和SUV，BM病灶中则为低DC和SUV。所有4种方法均成功确定了BM损伤，然而，扩散WB-MRI的阴性结果相对较少。FL 3级病例的SUV和CD值最高。使用扩散WB-MRI方法，评估了每位患者肿瘤病变的患病率（检测到淋巴结和结外病灶），计算了肿瘤总体积，进行了BM病变检测并计算了BM病变体积。需要注意的是，借助扩散WB-MRI，可以分别测量肿瘤总体积（462025 cm³）和体积较大的病灶体积（251358 cm³）。扩散WB-MRI使我们能够区分肿瘤组织体积（因治疗而减小）和残留（纤维脂肪）组织在残留结构中的体积（平均占初始体积的21%）。BM病灶中SUV最大值（超过14.0）和DC最小值（0.5×10⁻³mm²/s）是抗肿瘤反应不佳的预测指标。
扩散WB-MRI能够在FL初发时以及化疗疗效追踪过程中详细显示BM病变及周围软组织，这使得它可以与PET/CT一起使用。扩散WB-MRI能够分别评估真正肿瘤组织和残留组织的体积。FL 3级病例（包括FL转化为弥漫性B大细胞淋巴瘤）因肿瘤组织中DC值低（和SUV值高）而被区分出来。FL病变的BM病灶与淋巴结和结外病灶相比，DC值也较低。肿瘤（尤其是体积较大的肿瘤）中SUV值高（14.0及以上）和BM病灶DC值低（约0.5×10⁻³mm²/s）是抗肿瘤反应不佳的预测指标。PET/CT和扩散WB-MRI已被证明是确定FL分期和检测BM损伤的可靠诊断工具。FL的扩散WB-MRI是一种信息丰富的一线诊断方法，可用于定期监测疾病并早期发现复发和疾病进展病灶。
