Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, 725 Welch Rd, Palo Alto, CA, 94304, USA.
Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Eur Radiol. 2024 Jan;34(1):643-653. doi: 10.1007/s00330-023-10015-5. Epub 2023 Aug 5.
To compare tumor therapy response assessments with whole-body diffusion-weighted imaging (WB-DWI) and 18F-fluorodeoxyglucose ([F]FDG) PET/MRI in pediatric patients with Hodgkin lymphoma and non-Hodgkin lymphoma.
In a retrospective, non-randomized single-center study, we reviewed serial simultaneous WB-DWI and [F]FDG PET/MRI scans of 45 children and young adults (27 males; mean age, 13 years ± 5 [standard deviation]; age range, 1-21 years) with Hodgkin lymphoma (n = 20) and non-Hodgkin lymphoma (n = 25) between February 2018 and October 2022. We measured minimum tumor apparent diffusion coefficient (ADCmin) and maximum standardized uptake value (SUVmax) of up to six target lesions and assessed therapy response according to Lugano criteria and modified criteria for WB-DWI. We evaluated the agreement between WB-DWI- and [F]FDG PET/MRI-based response classifications with Gwet's agreement coefficient (AC).
After induction chemotherapy, 95% (19 of 20) of patients with Hodgkin lymphoma and 72% (18 of 25) of patients with non-Hodgkin lymphoma showed concordant response in tumor metabolism and proton diffusion. We found a high agreement between treatment response assessments on WB-DWI and [F]FDG PET/MRI (Gwet's AC = 0.94; 95% confidence interval [CI]: 0.82, 1.00) in patients with Hodgkin lymphoma, and a lower agreement for patients with non-Hodgkin lymphoma (Gwet's AC = 0.66; 95% CI: 0.43, 0.90). After completion of therapy, there was an excellent agreement between WB-DWI and [F]FDG PET/MRI response assessments (Gwet's AC = 0.97; 95% CI: 0.91, 1).
Therapy response of Hodgkin lymphoma can be evaluated with either [F]FDG PET or WB-DWI, whereas patients with non-Hodgkin lymphoma may benefit from a combined approach.
Hodgkin lymphoma and non-Hodgkin lymphoma exhibit different patterns of tumor response to induction chemotherapy on diffusion-weighted MRI and PET/MRI.
• Diffusion-weighted imaging has been proposed as an alternative imaging to assess tumor response without ionizing radiation. • After induction therapy, whole-body diffusion-weighted imaging and PET/MRI revealed a higher agreement in patients with Hodgkin lymphoma than in those with non-Hodgkin lymphoma. • At the end of therapy, whole-body diffusion-weighted imaging and PET/MRI revealed an excellent agreement for overall tumor therapy responses for all lymphoma types.
比较全身扩散加权成像（WB-DWI）和 18F-氟代脱氧葡萄糖 ([F]FDG) PET/MRI 在儿童霍奇金淋巴瘤和非霍奇金淋巴瘤患者中的肿瘤治疗反应评估。
在一项回顾性、非随机的单中心研究中，我们回顾了 2018 年 2 月至 2022 年 10 月期间 45 名患有霍奇金淋巴瘤（n=20）和非霍奇金淋巴瘤（n=25）的儿童和青少年（27 名男性；平均年龄 13 岁±5[标准差]；年龄范围 1-21 岁）的连续同步 WB-DWI 和 [F]FDG PET/MRI 扫描。我们测量了最多 6 个靶病变的最小肿瘤表观扩散系数（ADCmin）和最大标准化摄取值（SUVmax），并根据 Lugano 标准和 WB-DWI 改良标准评估治疗反应。我们使用 Gwet 一致性系数（AC）评估 WB-DWI 和 [F]FDG PET/MRI 基于反应分类之间的一致性。
在诱导化疗后，95%（20 例中的 19 例）的霍奇金淋巴瘤患者和 72%（25 例中的 18 例）的非霍奇金淋巴瘤患者在肿瘤代谢和质子扩散方面显示出一致的反应。我们发现霍奇金淋巴瘤患者的 WB-DWI 和 [F]FDG PET/MRI 治疗反应评估之间存在高度一致（Gwet 的 AC=0.94；95%置信区间 [CI]：0.82，1.00），而非霍奇金淋巴瘤患者的一致性较低（Gwet 的 AC=0.66；95%CI：0.43，0.90）。在完成治疗后，WB-DWI 和 [F]FDG PET/MRI 反应评估之间存在极好的一致性（Gwet 的 AC=0.97；95%CI：0.91，1）。
[F]FDG PET 或 WB-DWI 均可用于评估霍奇金淋巴瘤的治疗反应，而非霍奇金淋巴瘤患者可能受益于联合方法。
扩散加权 MRI 和 PET/MRI 显示霍奇金淋巴瘤和非霍奇金淋巴瘤对诱导化疗的肿瘤反应存在不同模式。
扩散加权成像已被提议作为一种替代成像方法，无需电离辐射即可评估肿瘤反应。
在诱导治疗后，全身扩散加权成像和 PET/MRI 在霍奇金淋巴瘤患者中的一致性高于非霍奇金淋巴瘤患者。
在治疗结束时，全身扩散加权成像和 PET/MRI 对所有淋巴瘤类型的整体肿瘤治疗反应显示出极好的一致性。
