Comparison of different MRI sequences in lesion detection and early response evaluation of diffuse large B-cell lymphoma - a whole-body MRI and diffusion-weighted imaging study

To compare different MRI sequences for the detection of lesions and the evaluation of response to chemotherapy in patients with diffuse large B-cell lymphoma (DLBCL), 18 patients with histology-confirmed DLBCL underwent 3-T MRI scanning prior to and 1 week after chemotherapy. The MRI sequences included T-1-weighted pre- and post-contrast, T-2-weighted with and without fat suppression, and a single-shot echo-planar diffusion-weighted imaging (DWI) with two b values (0 and 800 s/mm(2)). Conventional MRI sequence comparisons were performed using the contrast ratio between tumor and normal vertebral body instead of signal intensity. The apparent diffusion coefficient (ADC) of the tumor was measured directly on the parametric ADC map. The tumor volume was used as a reference for the evaluation of chemotherapy response. The mean tumor volume was 374 mL at baseline, and decreased by 65% 1 week after chemotherapy (p<0.01). The T-2-weighted image with fat suppression showed a significantly higher contrast ratio compared with images from all other conventional MRI sequences, both before and after treatment (p<0.01, respectively). The contrast ratio of the T-2-weighted image with fat suppression decreased significantly (p<0.01), and that of the T-1-weighted pre-contrast image increased significantly (p<0.01), after treatment. However, there was no correlation between the change in contrast ratio and tumor volume. The mean ADC value was 0.68x10(-3) mm(2)/s at baseline; it increased by 89% after chemotherapy (p<0.001), and the change in ADC value correlated with the change in tumor volume (r=0.66, p<0.01). The baseline ADC value also correlated inversely with the percentage change in ADC after treatment (r=-0.62, p<0.01). In conclusion, this study indicates that T-2-weighted imaging with fat suppression is the best conventional sequence for the detection of lesions and evaluation of the efficacy of chemotherapy in DLBCL. DWI with ADC mapping is an imaging modality with both diagnostic and prognostic value that could complement conventional MRI. Copyright (c) 2013 John Wiley & Sons, Ltd.