Whole-body diffusion-weighted MR and FDG-PET/CT in Hodgkin Lymphoma: Predictive role before treatment and early assessment after two courses of ABVD

Eur J Radiol. 2018 Jun:103:90-98. doi: 10.1016/j.ejrad.2018.04.014. Epub 2018 Apr 17.

Abstract

Purpose: To evaluate whether imaging features of pathologic lymph nodes on whole-body diffusion-weighted MR have a predictive role before treatment and may assess the response after two courses of chemotherapy in comparison to FDG-PET/CT in Hodgkin Lymphoma.

Materials and methods: We reviewed the whole-body MR and FDG-PET/CT performed on 41 patients with Hodgkin Lymphoma before and after two Doxorubicin-Bleomycin-Vinblastine-Dacarbazine (ABVD). Responder and non-responder lesions were identified on interim-FDG-PET/CT performed after two ABVD. We used Multivariate Generalized Estimating Equations model to assess statistical association between being-responder and baseline-Maximum Standard Uptake Value (SUVmax), baseline and interim-Apparent Diffusion Coefficient (ADC) and size, ADC and size changes during chemotherapy, site of disease, bulky, and stage.

Results: 10/41 (24%) patients were positive on interim-FDG-PET/CT. The interim-FDG-PET/CT positivity was associated with worse cumulative survival rate at 24 months in comparison to interim-FDG-PET/CT negativity (P < .05); 3/10 patients with positive interim-FDG-PET/CT and 1/31 with negative interim-FDG-PET/CT experienced disease progression. Baseline-SUVmax was 11.18 ± 5.58 (3.1-28.0) and baseline-ADC was 0.70 ± 0.14 × 10-3 mm2/s (0.39-0.98). There was a significant difference between responder and non-responder lesions based on interim-ADC (1.83 ± 0.34 × 10-3 mm2/s vs. 1.01 ± 0.27 × 10-3 mm2/s;p <.001), interim-size (3.1 cm2 vs. 9.4 cm2;p = .009), and bulky (8.2% vs. 66.7%;p = .002). There was no significant difference between responder and non-responder lesions based on baseline-SUVmax (p = .713), baseline-ADC (p = .253), ADC changes (p = .058), size changes (p = .085), site (p = .209), stage (p = .290), baseline-size (p = .064).

Conclusions: Interim-ADC is helpful for identifying non-responder lesions, while size changes are not useful. Baseline-SUVmax and ADC have no predictive role. Bulky is the most useful imaging parameter to predict suboptimal response to chemotherapy.

Keywords: ABVD; Diffusion weighted imaging; Hodgkin Lymphoma; Magnetic resonance imaging; Positron emission tomography; Whole body imaging.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Bleomycin / therapeutic use
  • Dacarbazine / therapeutic use
  • Diffusion Magnetic Resonance Imaging / methods*
  • Doxorubicin / therapeutic use
  • Female
  • Fluorodeoxyglucose F18*
  • Hodgkin Disease / diagnostic imaging*
  • Hodgkin Disease / drug therapy*
  • Humans
  • Male
  • Middle Aged
  • Positron Emission Tomography Computed Tomography / methods*
  • Predictive Value of Tests
  • Radiopharmaceuticals
  • Vinblastine / therapeutic use
  • Whole Body Imaging / methods*
  • Young Adult

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18
  • Bleomycin
  • Vinblastine
  • Dacarbazine
  • Doxorubicin

Supplementary concepts

  • ABVD protocol