Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
J Neurooncol. 2023 Oct;165(1):171-179. doi: 10.1007/s11060-023-04473-6. Epub 2023 Oct 13.
The treatment response of primary central nervous system lymphomas (PCNSLs) is mainly evaluated using postcontrast T1-weighted imaging (T1WI). Because poorly enhanced lesions may contain residual tumors, the combination of evaluation methods will potentially improve the accuracy of determining treatment effectiveness. In this study, we evaluated the usefulness of diffusion-weighted imaging (DWI) in predicting recurrence among patients with PCNSL who achieved complete response (CR)/unconfirmed CR (CRu).
Fifty-four patients newly diagnosed with PCNSL who were treated at our institution and achieved CR/CRu at the end of treatment were included in this study. The patients were divided into two groups according to the presence or absence of residual DWI hyperintense signal at the tumor site at the end of treatment. Kaplan-Meier analysis was performed to analyze the median overall survival (OS) and progression-free survival (PFS).
The mean age of the 54 patients was 66.4 ± 13.3 years. The induction therapies were HD-MTX in 20 patients, R-MPV in 29 patients, and other chemotherapies in five patients. Radiotherapy was performed in 35 patients, high-dose cytarabine therapy in 14 patients, and autologous hematopoietic stem cell transplantation in one patient, and of the 54 patients, 10 had no consolidation therapy. The residual DWI hyperintense signal sign was observed in 18 patients. The R-MPV regimen was statistically associated with a lower rate of residual DWI hyperintense signal (p = 0.0453). The median PFS was statistically shorter in the residual DWI hyperintense signal group than in the non-residual DWI hyperintense signal group (14.0 months vs. 85.1 months) (p < 0.0001, log-rank test).
A residual DWI hyperintense signal at the end of treatment was statistically associated with shorter PFS. Among patients who achieved CR/CRu evaluated based on postcontrast T1WI, DWI could be a valuable additional sequence to predict the early recurrence of PCNSL.
原发性中枢神经系统淋巴瘤（PCNSL）的治疗反应主要通过对比增强 T1 加权成像（T1WI）进行评估。由于强化程度较低的病变可能包含残留肿瘤，因此联合评估方法可能会提高确定治疗效果的准确性。在这项研究中，我们评估了弥散加权成像（DWI）在预测 PCNSL 患者达到完全缓解（CR）/未确认缓解（CRu）后复发中的作用。
本研究纳入了在我院接受治疗并在治疗结束时达到 CR/CRu 的 54 例新诊断为 PCNSL 的患者。根据治疗结束时肿瘤部位是否存在残留 DWI 高信号，将患者分为两组。采用 Kaplan-Meier 分析评估中位总生存期（OS）和无进展生存期（PFS）。
54 例患者的平均年龄为 66.4±13.3 岁。20 例患者接受 HD-MTX 诱导治疗，29 例患者接受 R-MPV 诱导治疗，5 例患者接受其他化疗。35 例患者接受放疗，14 例患者接受大剂量阿糖胞苷治疗，1 例患者接受自体造血干细胞移植，54 例患者中，10 例患者未接受巩固治疗。18 例患者存在残留 DWI 高信号。R-MPV 方案与残留 DWI 高信号发生率较低相关（p=0.0453）。残留 DWI 高信号组的中位 PFS 明显短于无残留 DWI 高信号组（14.0 个月 vs. 85.1 个月）（p<0.0001，对数秩检验）。
治疗结束时存在残留 DWI 高信号与较短的 PFS 相关。在基于对比增强 T1WI 评估达到 CR/CRu 的患者中，DWI 可能是一种有价值的附加序列，可以预测 PCNSL 的早期复发。
