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 outcome in primary central nervous system lymphoma.
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DOI：
10.3174/ajnr.a1750
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发表时间：
2010-01
期刊：
影响因子：
--
通讯作者：
Cha S
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文献类型：
--
作者：
Barajas RF Jr;Rubenstein JL;Chang JS;Hwang J;Cha S
有证据表明，原发性中枢神经系统淋巴瘤（PCNSL）诊断标本中肿瘤细胞密度增加可能具有重要的预后意义。由于细胞密度可能影响使用扩散加权MR成像（DWI）测量表观扩散系数（ADC），我们假设从对比增强区域测量的ADC可能与PCNSL患者的临床结局相关。采用治疗前DWI研究了18例免疫功能正常患者的PCNSL肿瘤，这些患者均接受了基于甲氨蝶呤的化疗。增强病灶经病理诊断为高级别B细胞淋巴瘤。将感兴趣区域放置在所有增强病变周围，以计算平均值、第25百分位数（ADC 25%）和最小ADC值。对所有患者的组织病理学肿瘤细胞结构进行定量测量。高ADC组和低ADC组按队列的中位ADC值分层。Welch t检验评估组间差异。Pearson相关性检查ADC测量值与肿瘤细胞密度之间的关系。进行单因素和多因素生存分析。我们在ADC测量中检测到显著的肿瘤内和肿瘤间异质性。观察到细胞密度和ADC测量值之间呈负相关（P <0.05）。ADC 25%测量值低于中位数692（低ADC组）与无进展生存期和总生存期显著缩短相关。观察到临床结局改善的患者在高剂量甲氨蝶呤化疗后ADC测量值显著降低。我们的研究提供的证据表明，ADC值内的对比度增强区域的PCNSL肿瘤可以提供无创的洞察临床结果。
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. 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 (ADC25%), 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. We detected significant intra- and intertumor heterogeneity in ADC measurements. An inverse correlation between cellular density and ADC measurements was observed (P < .05). ADC25% 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. Our study provides evidence that ADC measurements within contrast-enhancing regions of PCNSL tumors may provide noninvasive insight into clinical outcome.