Personalized Medicine and Imaging Evaluation of Diffusion-Weighted Magnetic Resonance Imaging for Follow-up and Treatment ResponseAssessment of Lymphoma:Results of an 18F-FDG-PET/CT–ControlledProspectiveStudy in 64 Patients

Purpose: To determine the value of diffusion-weighted MRI (DWI-MRI) for treatment response assessment in 2-[18F]fluoro2-deoxy-D-glucose (FDG)–avid lymphoma. Experimental Design: Patients with FDG-avid Hodgkin (HL) or non-Hodgkin lymphoma (NHL) at pretherapeutic 18F-FDGPET/CT, who had also undergone pretherapeutic whole-body DWI-MRI, were included in this prospective study. Depending on the histologic lymphoma subtype, patients received different systemic treatment regimens, and follow-up DWI-MRI and 18FFDG-PET/CTwere performed at one ormore timepoints, depending on the clinical course. For each follow-up DWI-MRI, regionbased rates of agreement, and rates of agreement in terms of treatment response (complete remission, partial remission, stable disease, or progressive disease), relative to the corresponding 18FFDG-PET/CT, were calculated. Results: Sixty-four patients were included: 10 with HL, 22 with aggressive NHL, and 32 with indolent NHL. The overall region-based agreement of DWI-MRI with 18F-FDG-PET/CT was 99.4%. For the 51 interim examinations (performed after 1–3 therapy cycles), region-based agreement of DWI-MRI with 18F-FDG-PET/CT was 99.2%, and for the 48 end-oftreatment examinations, agreement was 99.8%. No significant differences, in terms of region-based agreement between DWI-MRI and 18F-FDG-PET/CT, were observed between the three lymphoma groups (HL, aggressive NHL, indolent NHL; P 1⁄4 0.25), or between interim and end-of-treatment examinations (P 1⁄4 0.21). With regard to treatment response assessment, DWI-MRI agreed with 18F-FDG-PET/CT in 99 of 102 follow-up examinations (97.1%), with a k value of 0.94 (P < 0.0001). Conclusions: In patients with FDG-avid lymphoma, DWI-MRI may be a feasible alternative to 18F-FDG-PET/CT for follow-up and treatment response assessment.ClinCancer Res; 21(11); 2506–13.