Correlations between Functional Imaging Markers Derived from PET/CT and Diffusion-Weighted MRI in Diffuse Large B-Cell Lymphoma and Follicular Lymphoma

Xingchen Wu,Pirkko-Liisa Kellokumpu-Lehtinen,Pasi Korkola,Hannu Pertovaara,Prasun Dastidar,Ritva Järvenpää,Hannu Eskola,Enrique Hernandez-Lemus

doi:10.1371/journal.pone.0084999

Xingchen Wu, Pirkko-Liisa Kellokumpu-Lehtinen + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0084999

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Journal: PloS one	Publication Date: Jan 15, 2014
Citations: 54	License type: CC BY 4.0

Affiliation: Tampere University, Tampere University Hospital

Abstract

ObjectivesTo investigate the correlations between functional imaging markers derived from positron emission tomography/computed tomography (PET/CT) and diffusion-weighted magnetic resonance imaging (DWI) in diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). Further to compare the usefulness of these tumor markers in differentiating diagnosis of the two common types of Non-Hodgkin's lymphoma (NHL).Materials and MethodsThirty-four consecutive pre-therapy adult patients with proven NHL (23 DLBCL and 11 FL) underwent PET/CT and MRI examinations and laboratory tests. The maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and metabolic tumor burden (MTB) were determined from the PET/CT images. DWI was performed in addition to conventional MRI sequences using two b values (0 and 800 s/mm2). The minimum and mean apparent diffusion coefficient (ADCmin and ADCmean) were measured on the parametric ADC maps.ResultsThe SUVmax correlated inversely with the ADCmin (r = −0.35, p<0.05). The ADCmin, ADCmean, serum thymidine kinase (TK), Beta 2-microglobulin (B2m), lactate dehydrogenase (LD), and C-reactive protein (CRP) correlated with both whole-body MTV and whole-body MTB (p<0.05 or 0.01). The SUVmax, TK, LD, and CRP were significantly higher in the DLBCL group than in the FL group. Receiver operating characteristic curve analysis showed that they were reasonable predictors in differentiating DLBCL from FL.ConclusionsThe functional imaging markers determined from PET/CT and DWI are associated, and the SUVmax is superior to the ADCmin in differentiating DLBCL from FL. All the measured serum markers are associated with functional imaging markers. Serum LD, TK, and CRP are useful in differentiating DLBCL from FL.

Highlights

Non-Hodgkin’s lymphoma (NHL) represents a heterogeneous group of lymphoid malignancies that display varying patterns of biological behavior and response to treatment [1]
The SUVmax, thymidine kinase (TK), lactate dehydrogenase (LD), and C-reactive protein (CRP) were significantly higher in the diffuse large B-cell lymphoma (DLBCL) group than in the follicular lymphoma (FL) group
The functional imaging markers determined from Positron emission tomography/computed tomography (PET/CT) and diffusion-weighted magnetic resonance imaging (DWI) are associated, and the SUVmax is superior to the ADCmin in differentiating DLBCL from FL

Summary

Introduction

Non-Hodgkin’s lymphoma (NHL) represents a heterogeneous group of lymphoid malignancies that display varying patterns of biological behavior and response to treatment [1]. SUV reflects tumor glucose metabolism, and is commonly represented by the mean (SUVmean) or maximum (SUVmax) value. SUVmean is the average value generated from the entire tumor, but differences in operator contouring of tumor will yield varying values. Both SUVmax and SUVmean represent only the metabolic activity per gram of tissue, but they are not able to reflect tumor dimensions and volume. In order to take the number of lesion into consideration, SUVsum (summation of SUVmax for all tumors), whole-body MTV (MTVwb; summation of MTV for all tumors) and whole-body MTB (MTBwb; summation of MTB for all tumors) were calculated in the present study and used as indexes that could potentially reflect overall tumor activity or malignant process of the entire body [4]

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