Whole Tumor Histogram Analysis Using DW MRI in Primary Central Nervous System Lymphoma Correlates with Tumor Biomarkers and Outcome.

Chong Chong,Ostrom Ostrom,Garg Garg,Khan Khan,Dandachi Dandachi,Colen Colen,Morón Morón,Kotrotsou Kotrotsou

doi:10.3390/cancers11101506

Abstract

The ability to non-invasively predict outcomes and monitor treatment response in primary central nervous system lymphoma (PCNSL) is important as treatment regimens are constantly being trialed. The aim of this study was to assess the validity of using apparent diffusion coefficient (ADC) histogram values to predict Ki-67 expression, a tumor proliferation marker, and patient outcomes in PCNSL in both immunocompetent patients and patients living with HIV (PLWH). Qualitative PCNSL magnetic resonance imaging (MRI) characteristics from 93 patients (23 PLWH and 70 immunocompetent) were analyzed, and whole tumor segmentation was performed on the ADC maps. Quantitative histogram analyses of the segmentations were calculated. These measures were compared to PCNSL Ki-67 expression. Progression-free survival (PFS) and overall survival (OS) were analyzed via comparison to the International Primary Central Nervous System Lymphoma Collaboration Group Response Criteria. Associations between ADC measures and clinical outcomes were assessed using univariate and multivariate Cox proportional hazards models. Normalized ADC (nADC)Min, nADCMean, nADC1, nADC5, and nADC15 values were significantly associated with a poorer OS. nADCMax, nADCMean, nADC5, nADC15, nADC75, nADC95, nADC99 inversely correlated with Ki-67 expression. OS was also significantly associated with lesion hemorrhage. PFS was not significantly associated with ADC values but with lesion hemorrhage. ADC histogram values and related parameters can predict the degree of tumor proliferation and patient outcomes for primary central nervous system lymphoma patients and in both immunocompetent patients and patients living with HIV.

Highlights

Primary central nervous system lymphoma (PCNSL) represents a rare, aggressive subgroup of Non-Hodgkin Lymphoma [1,2]
In patients living with human immunodeficiency virus (HIV) (PLWH) is a distinct entity from other central nervous system (CNS) neoplasms as it is associated with the Epstein-Barr virus, which allows for the additional possibility of antiviral-based treatment regimens [1,2,3,4]
We retrospectively studied patients with primary central nervous system lymphoma (PCNSL) who were >18-years-old and had brain parenchymal PCNSL that presented to The University of Texas MD Anderson Cancer Center (MDACC)

Summary

Introduction

Primary central nervous system lymphoma (PCNSL) represents a rare, aggressive subgroup of Non-Hodgkin Lymphoma [1,2]. Cancers 2019, 11, 1506 a minority are associated with immunosuppression, such as in patients living with HIV (PLWH) [1,2,3]. Development of an ideal treatment regimen for PCNSL is complex as PCNSL in PLWH is a distinct entity from other central nervous system (CNS) neoplasms as it is associated with the Epstein-Barr virus, which allows for the additional possibility of antiviral-based treatment regimens [1,2,3,4]. Some studies have shown that the proportion of malignant cells positively stained for Ki-67 may have prognostic importance in PCNSL and correlate with clinical outcomes [8,9]

Objectives

Methods

Results

Discussion

Conclusion