Abstract
The lack of validation and standardization represents the main drawback for a clear role of whole-body diffusion weighted imaging (WB-DWI) for prediction and assessment of treatment response in Hodgkin’s lymphoma (HL). We explored the reliability of an automatic approach based on the WB-DWI technique for prediction and assessment of response to treatment in patients with HL. The study included 20 HL patients, who had whole-body positron emission tomography (PET)/ magnetic resonance Imaging (MRI) performed before, during and after chemotherapy. Using the syngo.via MR Total Tumor Load tool, we automatically extracted values of diffusion volume (DV) and its associated histogram features by WB-DWI images, and evaluated their utility in predicting and assessing interim and end-of-treatment (EOT) response. The Mann–Whitney test followed by receiver operator characteristic (ROC) analysis was performed between features and their inter-time point percentage differences for patients having a complete or partial treatment response, revealing that several WB-DWI associated features allowed for prediction of interim response and both prediction and assessment of EOT response. Our proposed method offers huge advantages in terms of saving time and work, enabling clinicians to draw conclusions relating to HL treatment response in a fully automatic way, and encloses, also, all DWI advantages compared to PET/ computed tomography (CT).
Highlights
Hodgkin’s lymphoma (HL) is a relatively uncommon B-cell derived tumor, in which the unique cellular microenvironment is crucial for accurate diagnosis and pathobiology [1,2,3]
Several studies investigate the power of diffusion weighted imaging (DWI) for HL and Non-Hodgkin’s (NHL) lymphoma diagnosis and assessment of treatment response compared to positron emission tomography (PET)/computed tomography (CT), showing the potential role of DWI for these purposes [8]
Inclusion criteria were patients being over the age of 18; histologic confirmation of HL at nodal biopsy; patients who underwent PET/CT followed by PET/magnetic resonance Imaging (MRI) with whole-body DWI (WB-DWI) at baseline before any treatment (T0), after two chemotherapy cycles (T1), and at the end-of-treatment (EOT)
Summary
Hodgkin’s lymphoma (HL) is a relatively uncommon B-cell derived tumor, in which the unique cellular microenvironment is crucial for accurate diagnosis and pathobiology [1,2,3]. The role of diagnostic imaging provides important information for an accurate pretreatment evaluation and assessment of response to treatment, which are crucial steps for a good management of HL patients. Diagnostics 2020, 10, 702 morphological information provided by the radiation-free MRI with the functional information that characterizes PET images. The characteristic DWI parameter is the apparent diffusion coefficient (ADC), which allows for a quantitative evaluation of changes in tissue cellularity, providing a useful tool for diagnosis and assessment of response to treatment in tumors, in particular for lymphomas. Several studies investigate the power of DWI for HL and Non-Hodgkin’s (NHL) lymphoma diagnosis and assessment of treatment response compared to PET/CT, showing the potential role of DWI for these purposes [8]
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