Diffusion-weighted MRI in early chemotherapy response evaluation of patients with diffuse large B-cell lymphoma - a pilot study: comparison with 2-deoxy-2-fluoro-D-glucose-positron emission tomography/computed tomography

To determine the feasibility of diffusion-weighted MRI (DWI) in the evaluation of the early chemotherapeutic response in patients with aggressive non-Hodgkin's lymphoma (NHL), eight patients with histologically proven diffuse large B-cell lymphoma were imaged by MRI, including DWI, and positron emission tomography/computed tomography (PET/CT) before treatment (E1), and after 1 week (E2) and two cycles (E3) of chemotherapy. In all patients, whole-body screening using T1- and T2-weighted images in the coronal plane was performed. To quantitatively evaluate the chemotherapeutic response, axial images including DWI were acquired. Apparent diffusion coefficient (ADC) maps were reconstructed, and the ADC value of the tumor was measured. In addition, the tumor volume was estimated on axial T2-weighted images. The maximum standardized uptake value (SUVmax) and active tumor volume were measured on fused PET/CT images. Lymphomas showed high signal intensity on DW images and low signal intensity on ADC maps, except for necrotic foci. The mean pre-therapy ADC was 0.71 x 10(-3) mm2/s; it increased by 77% at E2 (p<0.05) and 24% more at E3 (insignificant); the total increase was 106% (p<0.05). The mean tumor volume by MRI was 276 mL at baseline; it decreased by 58% at E2 (p<0.05) and 65% more at E3 (p<0.05), giving a total decrease of 84% (p<0.05). All the imaged pre-therapy tumors were strongly positive on PET/CT, with a mean SUVmax of 20. The SUVmax decreased by 60% at E2 (p<0.05) and 59% more at E3 (p<0.05), giving a total decrease of 83% (p<0.05). The active tumor burden decreased by 66% at E2 (p<0.05). At baseline, both central and peripheral tumor ADC values correlated inversely with SUVmax (p<0.05), and also correlated inversely with active tumor burden on PET/CT and with tumor volume on MRI at E2 (p<0.05). In conclusion, the results of DWI in combination with whole-body MRI were comparable with those of integrated PET/CT. Copyright (C) 2011 John Wiley & Sons, Ltd.