Application Of Diffusion Weighted Whole Body Imaging With Background Body Signal Suppression For Diagnosis And Treatment Efficiency Evaluation In Lymphoma

Part I The clinical evaluation of combining DWIBS with whole body T1 w imaging for diagnosing bone marrow involvement in lymphoma patients: a comparison with PET/CTObjective To evaluate the clinical value of the combining of DWIBS(diffusion weighted imaging with background signal suppression)with whole body T1 W imaging for diagnosing bone marrow involvement(BMI)in lymphoma patients,compared to PET/CT imaging.Materials and methods Patients with newly diagnosed lymphoma were included in this study and whole body DWIBS,T1 W and PET/CT images were acquired.The sensitivity,specificity,Youden index,positive predictive value,negative predictive value and the area under the receiver operating characteristic curve(ROC)was analyzed between different diagnosis methods.Mann-Whitney test(there is a statistical difference when P<0.05)was performed to compare the area under the ROC between different diagnosis methods.All the statistical analysis was performed with SAS9.3 software.Results BMI was confirmed in 20 patients.With patient numbers as study units,the diagnostic sensitivity of BMI with DWIBS was 0.70,and specificity was 0.67,the positive predictive value was 0.56,negative predictive value was 0.79,and Youden's index was 0.37.The diagnostic sensitivity of BMI with DWIBS with whole body T1 W imaging was 0.85 and specificity was 0.97,the positive predictive value was 0.94,negative predictive value was 0.91,and Youden's index was 0.82.The diagnostic sensitivity of BMI with PET/CT was 0.90 and specificity was 0.88,the positive predictive value was 0.82,negative predictive value was 0.94,and Youden's index was 0.78.In the assessment of the area under ROC curve,DWIBS with whole body T1 W imaging and PET/CT was statistically superior to DWIBS(P<0.001)and(P<0.001);while the difference between DWIBS with whole body T1 W imaging and PET/CT did not reach statistical significance in our population(P>0.05).Conclusions The combination of DWIBS with T1 W imaging can improve the ability of detecting BMI in lymphoma patients compared to DWIBS only.And it has the similar diagnostic ability compared to PET/CT imaging.Part ? The application value of DWIBS in differentiating diagnostic value between bone marrow involvement in lymphoma and hyperplastic hematopoietic bone marrowObjective To observe the application value of DWIBS in differentiating diagnostic value between BMI in lymphoma and hyperplastic hematopoietic bone marrow(HHBM).Materials and methods Fifty patients with newly diagnosed lymphoma were included in this study and including 11 cases of BMI,19 Cases of HHBM,20 cases of normal controls.DWIBS was acquired before the bone marrow puncture within 1 week.ADC values of the bone marrow puncture regions in BMI and HHBM groups and ADC values of Right posterior superior iliac spine were measured.The difference of ADC values among the three groups was compared by Single factor analysis of variance(one-way ANOVA).The heterogeneity of variance by the SNK test.Results The mean ADC value of BMI was 0.52±0.09×10-3mm2/s,while the HHBM group was 0.67 ± 0.18×10-3mm2/s and the normal controls group was 0.29 ±0.12×10-3mm2/s(between-group difference: F=39.86,P<0.0001).According to the result of SNK test,it showed significant differences of the ADC values between every two groups(P<0.05).Conclusions DWIBS in combination with the measurement of ADC values had important value in the differential diagnosis of BMI and HHBM.Part ? Additional value of DWIBS to evaluate proliferation of lymphoma: correlation with the apparent diffusion coefficientObjective The goal of this study was to evaluate whether ADC measurements could provide information on the proliferation of lymphoma.Materials and methods A total of 74 patients with newly diagnosed lymphoma were included in this study and DWIBS was acquired before the pathology examination.ADC values of biopsy or surgery regions were measured.We performed the histopathological analyses for the Ki-67 index and the classification of the lymphoma.Spearman correlation test was used to analyze the correlation of ADC value and Ki-67 index.ADC value and Ki-67 index were evaluated for characterisation of different lymphoma subtypes by Kruskal-Wallis test first,then comparisons among groups were performed by Nemenyi test.Results The ADC values were negatively correlative with Ki-67 index(r=-0.337,P=0.003).Kruskal-Wallis test showed significant differences on the Ki-67 index and ADC values of the three groups[(?2=25.757,P<0.001)and(?2=8.638,P=0.013)].Nemenyi test showed significant differences on the Ki-67 index of the aggressive NHL and indolent NHL(?2=15.933,P<0.001)and the aggressive NHL and HL(?2=12.700,P=0.002),while the difference was not significant of the indolent NHL and HL(?2=0.023,P=0.988).Nemenyi test showed no significant differences on the ADC values of the aggressive NHL and indolent NHL(?2=1.316,P=0.518)and the indolent NHL and HL(?2=1.799,P=0.407),while the difference was significant of the aggressive NHL and HL(?2=7.940,P=0.019).Conclusions The ADC values were negatively correlative with Ki-67 index and this finding can be useful in assessing the proliferation of lymphoma.However,the role of ADC values in prediction of different lymphoma subtypes needs to be confirmed in larger studies and longer follow-up.Part ? Diffusion weighted whole body imaging with background body signal suppression for early aassessment of the treatment response of lymph node in lymphomaObjective To evaluate the Diffusion weighted whole body imaging with background body signal suppression(DWIBS)for early aassessment of the treatment response of lymph node in lymphoma.Materials and methods Thirty-six patients newly diagnosed with lymphoma underwent 1.5 Tesla DWIBS before chemotherapy and after the second chemotherapy session(median 51 day;range 42–62 days).Apparent diffusion coefficient(ADC)values of the lymph node lesions were measured before and after treatment.According the patient response evaluation criteria,all the patients were divided into four groups:complete remission(CR),partial remission(PR),stable disease(SD)and progressive disease(PD).The difference of ADC values among the four groups before the treatment and among the PR,SD and PD groups after the treatment was compared by Single factor analysis of variance(one-way ANOVA).The heterogeneity of variance was compared by the SNK test.The comparison between the pre-treatment and post-treatment ADC values of the lymph node was carried out by using the paired t-test.The rate of ADC changes between baseline and after the second chemotherapy session of PR,SD and PD groups were compared using covariance analysis(covariate was the baseline data).Results One hundred and eighty-six lymph node lesions of 36 lymphoma patients were calculated before the treatment.After the second chemotherapy session,12 patients(84 lesions),17 patients(76 lesions),four patients(12 lesions),and three patients(14 lesions)were categorized into the CR,PR,SD and PD group,respectively.The mean pre-treatment ADC value of the four groups showed significant differences(F=9.27,P<0.0001)and the mean post-treatment ADC value of PR,SD and PD groups also showed significant differences(F=67.34,P<0.0001).The post-treatment ADC value of the PR group significantly increased(64.31±43.98%),while the post-treatment ADC value of the SD group slightly increased(0.47±17.78%)and it showed significantly decreased(-14.17±19.41%)of the PD group.The difference in the rate of change of ADC values in the PR,SD,PD groups before and after the treatment was significant(F=60.29,P<0.0001).Conclusions DWIBS with ADC values quantification enabled a good short-term response evaluation for lymph node in lymphoma.