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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Abstract
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.
Funding Information
  • the Joint Funds for the innovation of science and Technology, Fujian province (No.2025Y9219)
  • National Natural Science Foundation of China (No. 82371905)
  • Fujian Provincial Health Technology Project (No.2024CXA027)

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