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. 2013 Feb;26(1):49-55.
doi: 10.1007/s10334-012-0342-7. Epub 2012 Sep 16.

PET/MR for therapy response evaluation in malignant lymphoma: initial experience

Ivan Platzek  1 , Bettina Beuthien-Baumann, Jens Langner, Manuel Popp, Georg Schramm, Rainer Ordemann, Michael Laniado, Jörg Kotzerke, Jörg van den Hoff
Affiliations

PET/MR for therapy response evaluation in malignant lymphoma: initial experience

Ivan Platzek et al. MAGMA. 2013 Feb.

Abstract

Object: To evaluate the feasibility of positron emission tomography/magnetic resonance imaging (PET/MR) with (18)fluoro-2-deoxyglucose (FDG) for therapy response evaluation of malignant lymphoma.

Materials and methods: Nine patients with malignant lymphoma who underwent FDG-PET/MR before and after chemotherapy were included in this retrospective study. Average time between the two scans was 70 days. The scans were evaluated independently by two nuclear medicine physicians. The Ann Arbor classification was used to describe lymphoma stage. Furthermore, the readers also rated PET image quality using a five point scale. Weighted kappa (κ) was used to calculate interrater agreement.

Results: The initial scan showed foci of increased FDG uptake in all patients, with Ann Arbor stage varying between I and IV. In the follow-up examination, all but one patient showed complete response to chemotherapy. PET image quality was rated as very good or excellent for all scans. Interrater agreement was excellent regarding Ann Arbor stage (κ = 0.97) and good regarding image quality (κ = 0.41).

Conclusion: PET/MR shows promising initial results for therapy response evaluation in lymphoma patients.

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Figures

Fig. 1
Fig. 1
a Whole-body PET/MR system; b attenuation MR, a low-resolution gradient echo scan; c FDG-PET scan; d fused PET/MR image
Fig. 2
Fig. 2
FDG-PET/MR in a patient with Hodgkin’s disease before and after chemotherapy. a PET MIP image showing enlarged lymph nodes with increased FDG uptake in the mediastinum and the right axilla. b Inverted MIP of diffusion weighted MR images acquired during the same exam, with the lymphoma mentioned above clearly recognizable. c PET MIP after chemotherapy, showing complete response. d Corresponding inverted DWIBS MIP. Non-specific symmetric FDG-accumulation in brown fat tissue in the lower cervical and supraclavicular region on both PET scans (more pronounced on the second PET with additional paravertebral symmetric FDG uptake) should not be mistaken as lymphoma tissue. Signal decrease in the lower cervical region on the inverted diffusion weighted images is caused by inhomogenous fat suppression (DWIBS Images are acquired with the integrated body coil of the MR system)
Fig. 3
Fig. 3
Artifacts caused by a port system impacted on the right side of the patients chest. a Susceptibility artifacts on the attenuation MR scan (arrow). b Corresponding defect on the MRMap, a template calculated from the attenuation scan and used for attenuation correction. c On the PET scan, the port is recognizable as an area without visible FDG uptake (arrow). Image quality in the surrounding area does not appear to be degraded by the metal artifacts
Fig. 4
Fig. 4
FDG-PET/MR and corresponding CT images of a patient with diffuse large B cell lymphoma. a Contrast enhanced CT scan showing a hepatic lymphoma manifestation before chemotherapy. b Fused FDG-PET/MR before chemotherapy. c Nonenhanced CT scan after chemotherapy showing a residual mass (arrow). d Corresponding PET/MR after chemotherapy showing no pathologic FDG uptake
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