Objectives The purpose of this study was to evaluate the role of SWI and DWI in predicting the relapsed/refractory primary central nervous system lymphoma (R/R PCNSL). Materials and methods Seventy-seven patients with histologically confirmed PCNSL were enrolled. Patients were divided into R/R group (n = 40) and Non-R/R group (n = 37), according to follow-up outcomes. Demographics, pathological indicators, conventional MRI characteristics, pre-chemotherapy intratumoral susceptibility signal (ITSS) grade, ADC parameters, including pre-chemotherapy relative minimum ADC (rADCmin−pre) and relative mean ADC (rADCmean−pre), post-chemotherapy relative minimum ADC (rADCmin−post) and relative mean ADC (rADCmean−post), as well as the change in relative minimum ADC (rADCmin−change) and relative mean ADC (rADCmean−change), were compared between the two groups. Receiver operating characteristic curves and logistic regression analysis were used to assess the predictive performance. Results Compared with Non-R/R PCNSL group, R/R PCNSL group showed significantly lower Ki-67 index (P = 0.004) but higher pre-chemotherapy ITSS grade (P < 0.001). The comparison of rADCmin−pre and rADCmean−pre between the two groups showed no significant differences (P > 0.05). However, among the 50 patients with available post-treatment ADC data, rADCmin−post, rADCmean−post, rADCmin−change and rADCmean−change in R/R group were significantly lower than in Non-R/R group (all P < 0.001). The predictive performance of rADCmin−post, rADCmean−post, rADCmin−change and rADCmean−change was comparable to that of pre-chemotherapy ITSS grade for R/R PCNSL (0.894 vs. 0.714, 0.867 vs. 0.714, 0.877 vs. 0.714, 0.814 vs. 0.714, all P > 0.05), but superior to that of Ki-67 index (0.894 vs. 0.665, 0.867 vs. 0.665, 0.877 vs. 0.665, 0.814 vs. 0.665, all P < 0.05). Conclusions The pre-chemotherapy ITSS grade, rADCmin−post, rADCmean−post, rADCmin−change and rADCmean−change may serve as preferable imaging biomarkers for predicting R/R PCNSL, and compare favorably with Ki-67 index.

Prediction of relapsed/refractory primary central nervous system lymphoma using pre-chemotherapy ITSS grade on SWI and pre-/post-chemotherapy ADC parameters on DWI

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2026年4月30日

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Yijing Zhao,
Feiman Yang,
Meina Li,
Feifei Yu,
Na Lin,
Dairong Cao,
Zhen Xing

摘要

Objectives

The purpose of this study was to evaluate the role of SWI and DWI in predicting the relapsed/refractory primary central nervous system lymphoma (R/R PCNSL).

Materials and methods

Seventy-seven patients with histologically confirmed PCNSL were enrolled. Patients were divided into R/R group (n = 40) and Non-R/R group (n = 37), according to follow-up outcomes. Demographics, pathological indicators, conventional MRI characteristics, pre-chemotherapy intratumoral susceptibility signal (ITSS) grade, ADC parameters, including pre-chemotherapy relative minimum ADC (rADC_min−pre) and relative mean ADC (rADC_mean−pre), post-chemotherapy relative minimum ADC (rADC_min−post) and relative mean ADC (rADC_mean−post), as well as the change in relative minimum ADC (rADC_min−change) and relative mean ADC (rADC_{mean−change}), were compared between the two groups. Receiver operating characteristic curves and logistic regression analysis were used to assess the predictive performance.

Results

Compared with Non-R/R PCNSL group, R/R PCNSL group showed significantly lower Ki-67 index (P = 0.004) but higher pre-chemotherapy ITSS grade (P < 0.001). The comparison of rADC_min−pre and rADC_mean−pre between the two groups showed no significant differences (P > 0.05). However, among the 50 patients with available post-treatment ADC data, rADC_min−post, rADC_mean−post, rADC_min−change and rADC_{mean−change} in R/R group were significantly lower than in Non-R/R group (all P < 0.001). The predictive performance of rADC_min−post, rADC_mean−post, rADC_min−change and rADC_{mean−change} was comparable to that of pre-chemotherapy ITSS grade for R/R PCNSL (0.894 vs. 0.714, 0.867 vs. 0.714, 0.877 vs. 0.714, 0.814 vs. 0.714, all P > 0.05), but superior to that of Ki-67 index (0.894 vs. 0.665, 0.867 vs. 0.665, 0.877 vs. 0.665, 0.814 vs. 0.665, all P < 0.05).

Conclusions

The pre-chemotherapy ITSS grade, rADC_min−post, rADC_mean−post, rADC_min−change and rADC_{mean−change} may serve as preferable imaging biomarkers for predicting R/R PCNSL, and compare favorably with Ki-67 index.