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Diffusion-Weighted MR Imaging Derived Apparent Diffusion Coefficient Is Predictive of Clinical Outcome in Primary Central Nervous System Lymphoma

Diffusion-Weighted MR Imaging Derived Apparent Diffusion Coefficient Is Predictive of Clinical... This Article Free to Access Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A1750v1 ajnr.A1750v2 31/1/60 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Barajas, R.F. Articles by Cha, S. PubMed PubMed Citation Articles by Barajas, R.F., Jr Articles by Cha, S. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 31:60-66, January 2010 © 2010 American Society of Neuroradiology BRAIN Diffusion-Weighted MR Imaging Derived Apparent Diffusion Coefficient Is Predictive of Clinical Outcome in Primary Central Nervous System Lymphoma R.F. Barajas, Jr a , J.L. Rubenstein b , J.S. Chang a , J. Hwang c and S. Cha a a From the Department of Radiology (R.F.B., J.S.C., S.C.), Neuroradiology Section b Division of Hematology/Oncology (J.L.R.) c Helen Diller Family Comprehensive Cancer Center (J.H.); University of California San Francisco, San Francisco, California. Please address correspondence to Soonmee Cha, MD, UCSF Department of Radiology, 350 Parnassus Ave, Ste 307, Room 307H, Box 0336, San Francisco, CA 94117; e-mail: [email protected] BACKGROUND AND PURPOSE: There is evidence that increased tumor cellular density within diagnostic specimens of primary central nervous system lymphoma (PCNSL) may have significant prognostic implications. Because cellular density may influence measurements of apparent diffusion coefficient (ADC) by using diffusion-weighted MR imaging (DWI), we hypothesized that ADC measured from contrast-enhancing regions might correlate with clinical outcome in patients with PCNSL. MATERIALS AND METHODS: PCNSL tumors from 18 immunocompetent patients, treated uniformly with methotrexate-based chemotherapy, were studied with pretherapeutic DWI. Enhancing lesions were diagnosed by pathologic analysis as high-grade B-cell lymphomas. Regions of interest were placed around all enhancing lesions allowing calculation of mean, 25th percentile (ADC 25% ), and minimum ADC values. Histopathologic tumor cellularity was quantitatively measured in all patients. High and low ADC groups were stratified by the median ADC value of the cohort. The Welch t test assessed differences between groups. The Pearson correlation examined relationships between ADC measurements and tumor cellular density. Single and multivariable survival analysis was performed. RESULTS: We detected significant intra- and intertumor heterogeneity in ADC measurements. An inverse correlation between cellular density and ADC measurements was observed ( P < .05). ADC 25% measurements less than the median value of 692 (low ADC group) were associated with significantly shorter progression-free and overall survival. Patients with improved clinical outcome were noted to exhibit a significant decrease in ADC measurements following high-dose methotrexate chemotherapy. CONCLUSIONS: Our study provides evidence that ADC measurements within contrast-enhancing regions of PCNSL tumors may provide noninvasive insight into clinical outcome. Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Diffusion-Weighted MR Imaging Derived Apparent Diffusion Coefficient Is Predictive of Clinical Outcome in Primary Central Nervous System Lymphoma

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2010 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A1750
Publisher site
See Article on Publisher Site

Abstract

This Article Free to Access Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A1750v1 ajnr.A1750v2 31/1/60 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Barajas, R.F. Articles by Cha, S. PubMed PubMed Citation Articles by Barajas, R.F., Jr Articles by Cha, S. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 31:60-66, January 2010 © 2010 American Society of Neuroradiology BRAIN Diffusion-Weighted MR Imaging Derived Apparent Diffusion Coefficient Is Predictive of Clinical Outcome in Primary Central Nervous System Lymphoma R.F. Barajas, Jr a , J.L. Rubenstein b , J.S. Chang a , J. Hwang c and S. Cha a a From the Department of Radiology (R.F.B., J.S.C., S.C.), Neuroradiology Section b Division of Hematology/Oncology (J.L.R.) c Helen Diller Family Comprehensive Cancer Center (J.H.); University of California San Francisco, San Francisco, California. Please address correspondence to Soonmee Cha, MD, UCSF Department of Radiology, 350 Parnassus Ave, Ste 307, Room 307H, Box 0336, San Francisco, CA 94117; e-mail: [email protected] BACKGROUND AND PURPOSE: There is evidence that increased tumor cellular density within diagnostic specimens of primary central nervous system lymphoma (PCNSL) may have significant prognostic implications. Because cellular density may influence measurements of apparent diffusion coefficient (ADC) by using diffusion-weighted MR imaging (DWI), we hypothesized that ADC measured from contrast-enhancing regions might correlate with clinical outcome in patients with PCNSL. MATERIALS AND METHODS: PCNSL tumors from 18 immunocompetent patients, treated uniformly with methotrexate-based chemotherapy, were studied with pretherapeutic DWI. Enhancing lesions were diagnosed by pathologic analysis as high-grade B-cell lymphomas. Regions of interest were placed around all enhancing lesions allowing calculation of mean, 25th percentile (ADC 25% ), and minimum ADC values. Histopathologic tumor cellularity was quantitatively measured in all patients. High and low ADC groups were stratified by the median ADC value of the cohort. The Welch t test assessed differences between groups. The Pearson correlation examined relationships between ADC measurements and tumor cellular density. Single and multivariable survival analysis was performed. RESULTS: We detected significant intra- and intertumor heterogeneity in ADC measurements. An inverse correlation between cellular density and ADC measurements was observed ( P < .05). ADC 25% measurements less than the median value of 692 (low ADC group) were associated with significantly shorter progression-free and overall survival. Patients with improved clinical outcome were noted to exhibit a significant decrease in ADC measurements following high-dose methotrexate chemotherapy. CONCLUSIONS: Our study provides evidence that ADC measurements within contrast-enhancing regions of PCNSL tumors may provide noninvasive insight into clinical outcome. Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X

Journal

American Journal of Neuroradiology – American Journal of Neuroradiology

Published: Jan 1, 2010

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