Prediction of relapsed/refractory primary central nervous system lymphoma using pre-chemotherapy ITSS grade on SWI
Yijing Zhao1,2, Feiman Yang1, Meina Li1,2
1Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
Objectives:
The purpose of this study was to evaluate the role of SWI and DWI in predicting the relapsed/refractory primary central nervous system lymphoma (R/R PCNSL).
Materials And Methods:
Seventy-seven patients with histologically confirmed PCNSL were enrolled. Patients were divided into R/R group (n = 40) and Non-R/R group (n = 37), according to follow-up outcomes. Demographics, pathological indicators, conventional MRI characteristics, pre-chemotherapy intratumoral susceptibility signal (ITSS) grade, ADC parameters, including pre-chemotherapy relative minimum ADC (rADCmin-pre) and relative mean ADC (rADCmean-pre), post-chemotherapy relative minimum ADC (rADCmin-post) and relative mean ADC (rADCmean-post), as well as the change in relative minimum ADC (rADCmin-change) and relative mean ADC (rADCmean-change), were compared between the two groups. Receiver operating characteristic curves and logistic regression analysis were used to assess the predictive performance.
Results:
Compared with Non-R/R PCNSL group, R/R PCNSL group showed significantly lower Ki-67 index (P = 0.004) but higher pre-chemotherapy ITSS grade (P < 0.001). The comparison of rADCmin-pre and rADCmean-pre between the two groups showed no significant differences (P > 0.05). However, among the 50 patients with available post-treatment ADC data, rADCmin-post, rADCmean-post, rADCmin-change and rADCmean-change in R/R group were significantly lower than in Non-R/R group (all P < 0.001). The predictive performance of rADCmin-post, rADCmean-post, rADCmin-change and rADCmean-change was comparable to that of pre-chemotherapy ITSS grade for R/R PCNSL (0.894 vs. 0.714, 0.867 vs. 0.714, 0.877 vs. 0.714, 0.814 vs. 0.714, all P > 0.05), but superior to that of Ki-67 index (0.894 vs. 0.665, 0.867 vs. 0.665, 0.877 vs. 0.665, 0.814 vs. 0.665, all P < 0.05).
Conclusions:
The pre-chemotherapy ITSS grade, rADCmin-post, rADCmean-post, rADCmin-change and rADCmean-change may serve as preferable imaging biomarkers for predicting R/R PCNSL, and compare favorably with Ki-67 index.
