Evaluation of Diffusion-Weighted Magnetic Resonance Imaging for Follow-up and Treatment Response Assessment of Lymphoma: Results of an 18F-FDG-PET/CT-Controlled Prospective Study in 64 Patients.
OBJECTIVE
To determine the value of diffusion-weighted MRI (DWI-MRI) for treatment response assessment in 2-[18F]fluoro-2-deoxy-D-glucose (FDG)-avid lymphoma.


METHODS
Patients with FDG-avid Hodgkin (HL) or non-Hodgkin lymphoma (NHL) at pretherapeutic 18F-FDG-PET/CT, who had also undergone pretherapeutic whole-body DWI-MRI, were included in this prospective study. Depending on the histologic lymphoma subtype, patients received different systemic treatment regimens, and follow-up DWI-MRI and 18F-FDG-PET/CT were performed at one or more time points, depending on the clinical course. For each follow-up DWI-MRI, region-based rates of agreement, and rates of agreement in terms of treatment response (complete remission, partial remission, stable disease, or progressive disease), relative to the corresponding 18F-FDG-PET/CT, were calculated.


RESULTS
Sixty-four patients were included: 10 with HL, 22 with aggressive NHL, and 32 with indolent NHL. The overall region-based agreement of DWI-MRI with 18F-FDG-PET/CT was 99.4%. For the 51 interim examinations (performed after 1-3 therapy cycles), region-based agreement of DWI-MRI with 18F-FDG-PET/CT was 99.2%, and for the 48 end-of-treatment examinations, agreement was 99.8%. No significant differences, in terms of region-based agreement between DWI-MRI and 18F-FDG-PET/CT, were observed between the three lymphoma groups (HL, aggressive NHL, indolent NHL; P = 0.25), or between interim and end-of-treatment examinations (P = 0.21). With regard to treatment response assessment, DWI-MRI agreed with 18F-FDG-PET/CT in 99 of 102 follow-up examinations (97.1%), with a κ value of 0.94 (P < 0.0001).


CONCLUSIONS
In patients with FDG-avid lymphoma, DWI-MRI may be a feasible alternative to 18F-FDG-PET/CT for follow-up and treatment response assessment.
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria. marius.mayerhoefer@meduniwien.ac.at.
Marius E
ME
Mayerhoefer
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Georgios
G
Karanikas
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Kurt
K
Kletter
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Helmut
H
Prosch
Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
Barbara
B
Kiesewetter
Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
Cathrin
C
Skrabs
Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
Edit
E
Porpaczy
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Michael
M
Weber
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Thomas
T
Knogler
Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
Christian
C
Sillaber
Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
Ulrich
U
Jaeger
Institute of Pathology, Medical University Vienna, Vienna, Austria.
Ingrid
I
Simonitsch-Klupp
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Philipp
P
Ubl
Institute of Pathology, Medical University Vienna, Vienna, Austria.
Leonhard
L
Müllauer
Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
Werner
W
Dolak
Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
Julius
J
Lukas
Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
Markus
M
Raderer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011859:Radiography; D051598:Whole Body Imaging
D019788:Fluorodeoxyglucose F18