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Very early indicators of response to systemic therapy in lymphoma patients based on alterations in water
M Horger1, C Claussen1, U Kramer1
1Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
Objective:
To assess feasibility of whole-body diffusion-weighted MRI (wbDWI) for very early evaluation of response to therapy in different lymphoma subtypes.
Materials And Methods:
20 patients (10 male, 10 female; mean age 50.7±16.1±17.2 years) underwent wbDWI (calculation of apparent diffusion coefficient [ADC] with b=0, 800s/mm(2)) at baseline and within a median of 7 days after therapy onset. Lymphoma manifestations were evaluated with respect to changes in ADC and size at follow-up with up to six of the largest lesions per patient undergoing quantification. An increase in ADC as well as a decrease in size at follow-up was classified as responder, whereas neither change in ADC nor in size (or progression) was considered non-responder. Results were confirmed at interim measurements (after 3-4 chemotherapy cycles) and 6 months after treatment.
Results:
90 lymphoma lesions were analyzed. 18 patients were classified as responders and 2 as non-responder at FU (mean, 1 week). DWI results accurately (100%) correlated with the subsequent interim course of all lesions. mean baseline ADC was 0.79±0.28×10(-3)s/mm(2). For responders mean follow-upADC increased by 64.6±56.5% (p<0.001) whereas lesions size decreased by mean 14.4±13.3% (p<0.001). In the non-responder, both values did not significantly change. In patients classified as responders six months after treatment, meanADC increase at FU was 70.3±57.8% (p<0.001) whereas mean size decrease vs. baseline was 15.8±13.6% as compared to non-responders (22.4±39.9%) and 5.4±0.9%, respectively.
Conclusion:
wbDWI with ADC analysis represents a feasible diagnostic tool for very early response assessment in lymphoma patients enabling also prediction of long-term response.
