Quantitative diffusion weighted MRI: A functional biomarker of nodal disease in Hodgkin lymphoma?

Issue title: Metastasis Imaging: Current Concepts and Future Challenges

Guest editors: Christina Messiou and Nandita M. de Souza

Article type: Research Article

Authors: Punwani, Shonit^{a; b; *} | Prakash, Vineet^{a; c} | Bainbridge, Alan^{a; d} | Taylor, Stuart A.^{a; b} | Bandula, Steven^a | Olsen, Oystein E^e | Hain, Sharon F.^c | Shankar, Ananth^f | Daw, Stephen^f | Humphries, Paul^a

Affiliations: [a] Department of Specialist Radiology, University College Hospital, London, UK | [b] Centre for Medical Imaging, University College London, London, UK | [c] Institute of Nuclear Medicine, University College Hospital, London, UK | [d] Department of Medical Physics and Bioengineering, University College London, London, UK | [e] Department of Radiology, Great Ormond Street Hospital, Great Ormond Street, London, UK | [f] Department of Paediatrics, University College Hospital, London, UK | Cancer Research UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK

Correspondence: [*] Corresponding author: Dr. Shonit Punwani, Centre for Medical Imaging, Level 3 East, 250 Euston Road, London, UK. NW1 2PG, Tel.: 0845 1555000 ext 73225 Fax: N/A; E-mail: shonit.punwani@gmail.com.

Abstract: Purpose:This study explores the relationship between MRI Apparent Diffusion Coefficient (ADC) and PET Standardized Uptake Value (SUV) measurements in pediatric Hodgkin lymphoma. Methods:Sixteen patients (mean age 15.4 yrs, 8 male) with proven Hodgkin lymphoma were recruited and staged using PET-CT, anatomical MRI and additional 1.5T diffusion weighted imaging (DWI) prior to and following chemotherapy. Pre-treatment lymph nodes and anatomically paired post-treatment residual tissue located on MRI were matched to the corresponding PET-CT. Region of interest (ROI) analysis was used to extract quantitative measurements. Mean ADC (ADCmean) and maximum SUV (SUVmax) were recorded and correlation assessed using Spearman statistics. Results:Fifty-three ROIs were sampled. Pre- and post-treatment ADCmean ranged from 0.77 × 10-3 to 1.79 × 10-3 (median 1.15 × 10-3 mm2s-1) and 1.08 × 10-3 to 3.18 × 10-3 (median 1.88 × 10-3mm2s-1), and SUVmax from 2.60 to 25.4 (median 8.85 mg/ml) and 1.00 to 3.50 mg/ml (median 1.90 mg/ml). Median post-treatment ADCmean was higher, and median SUVmax lower than pre-treatment values (p< 0.0001). There was an inverse correlation between pre-treatment ADCmean and SUVmax (p=0.005) and between fractional change ([post-treatment – pre-treatment]/pre-treatment) in ADCmean and SUVmax (p=0.002). Conclusion:Our results confirm a strong reciprocal relationship between nodal ADCmean and SUVmax in Hodgkin lymphoma; supporting the potential application of quantitative DWI as a functional biomarker of disease.

Keywords: Diffusion magnetic resonance imaging, positron-emission tomography, lymphoma, child, adolescent

DOI: 10.3233/CBM-2010-0197

Journal: Cancer Biomarkers, vol. 7, no. 4-5, pp. 249-259, 2010