Ultra-early response assessment in lymphoma treatment: [18F]FDG PET/MR captures changes in glucose metabolism and cell density within the first 72 hours of treatment

Abstract

PurposeTo determine whether, in patients with Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL), [18F]FDG PET/MR can capture treatment effects within the first week after treatment initiation, and whether changes in glucose metabolism and cell density occur simultaneously.MethodsPatients with histologically proven HL or NHL were included in this prospective IRB-approved study. Patients underwent [18F]FDG PET/MR before, and then 48–72 h after (follow-up 1, FU-1) and 1 week after (FU-2) initiation of the first cycle of their respective standard chemotherapy (for HL) or immunochemotherapy (for NHL). Standardized [18F]FDG uptake values (SUVmax, SUVmean) and apparent diffusion coefficients (ADCmin, ADCmean) based on diffusion-weighted MRI, and metabolic and morphological tumour volumes (MTV, VOL) were assessed at each time-point. Multilevel analyses with an unstructured covariance matrix, and pair-wise post-hoc tests were used to test for significant changes in SUVs, ADCs, MTVs and VOLs between the three time-points.ResultsA total of 58 patients (11 with HL and 47 with NHL) with 166 lesions were analysed. Lesion-based mean rates of change in SUVmax, SUVmean, ADCmin, ADCmean, MTV and VOL between baseline and FU-1 were −46.8%, −33.3%, +20.3%, +14%, −46% and −12.8%, respectively, and between baseline and FU-2 were −65.1%, −49%, +50.7%, +32.4%, −61.1% and −24.2%, respectively. These changes were statistically significant (P < 0.01) except for the change in VOL between baseline and FU-1 (P = 0.079).ConclusionIn lymphoma patients, [18F]FDG PET/MR can capture treatment-induced changes in glucose metabolism and cell density as early as 48–72 h after treatment initiation.Electronic supplementary materialThe online version of this article (10.1007/s00259-018-3937-z) contains supplementary material, which is available to authorized users.

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“…Our findings partly support this hypothesis; all tumors decreased in size during therapy (independent of later response), but these changes were very small and occurred later than observed changes in SUV and ADC. This is also confirmed by another recent study applying FDG-PET/MR for very early response evaluation [41].…”

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