Katja Natascha De Paepe MD, Abstract Co-Author: Nothing to Disclose

Charlotte Bevernage MD, Abstract Co-Author: Nothing to Disclose

Frederik De Keyzer MSc, Abstract Co-Author: Nothing to Disclose

Pascal Wolter MD, Abstract Co-Author: Nothing to Disclose

Raymond Oyen MD, PhD, Abstract Co-Author: Nothing to Disclose

Gregor Verhoef MD,PhD, Abstract Co-Author: Nothing to Disclose

Vincent Vandecaveye, Abstract Co-Author: Nothing to Disclose

Katrijn Michielsen PhD, Presenter: Nothing to Disclose

Whole body diffusion-weighted magnetic resonance imaging (WB-DWI) uses combined anatomical and functional tumor properties for tumor staging and response assessment. The aim of this study was to evaluate WB-DWI for early assessment of chemotherapy in Diffuse large B-cell lymphoma (DLBCL).  

Fourteen patients with DLBCL treated with CHOP plus rituximab (R-CHOP) were evaluated by WB-DWI. Prior to, 2 and 4 weeks after initiation of treatment, patients underwent WB-DWI at 3 Tesla (T) field-strength with 2 b-values (b=0-1000 s/mm2), from which the apparent diffusion coefficient (ADC) was calculated. Pretreatment ADC, ADC-change to pretreatment ADC (ADCbase) at 2 weeks (ADCratio2w) and 4 weeks (ADCratio4w) during treatment of responding and non-responding lesions were compared using a Mann-Whitney-U test. The predictive value per patient of ADCbase, ADCratio2w and ADCratio4w were correlated to progression-free survival (PFS) with a log rank test, including the effect of the international prognostic index (IPI).

Eight patients showed complete remission after 18 months of follow-up, whereas 6 patients showed persistent or recurrent disease within 5 to 15 months. The ADCbase, ADCratio2w and ADCratio4w were significantly different in lesions showing recurrence versus remission (ADCbase= 0.96x±0.3x10-3 mm/s2 versus 1.04±0.2x10-3 mm/s2, p<0.0001; ADCratio2w= in %:-9±20 versus 78±64, p<0.0001 ; ADCratio4w= in %:12±35 versus129±75, p<0.0001). Per body region, the ADCratio2w showed highest accuracy of 91% with a negative predictive value of 100% and positive predictive value of 91%. Differences in ADCbase, ADCratio2w and ADCratio4w between patient groups correlated significantly with PFS (ADCbase – p=0.028 , ADCratio2w – p=0.0029 and ADCratio4w– p=0.00023), while the IPI did not.  

WB-DWI may allow for treatment prediction and early treatment assessment of DLBCL using differences in ADCbase, ADCratio2w and ADCratio4w.

Treatment prediction and early recognition of treatment response in DLBCL patients may allow for early identification of responders and non-responders possibly resulting in adaptation of treatment.

De Paepe, K, Bevernage, C, De Keyzer, F, Wolter, P, Oyen, R, Verhoef, G, Vandecaveye, V, Michielsen, K, Early Treatment Assessment and Treatment Prediction with 3 T Whole-Body Diffusion-weighted Magnetic Resonance Imaging (WB-DWI).  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11007632.html