Whole-body diffusion-weighted MR and FDG-PET/CT in Hodgkin Lymphoma: Predictive role before treatment and early assessment after two courses of ABVD

Purpose To evaluate whether imaging features of pathologic lymph nodes on whole-body diffusion-weighted MR have a predictive role before treatment and may assess the response after two courses of chemotherapy in comparison to FDG-PET/CT in Hodgkin Lymphoma. Materials and methods We reviewed the whole-body MR and FDG-PET/CT performed on 41 patients with Hodgkin Lymphoma before and after two Doxorubicin-Bleomycin-Vinblastine-Dacarbazine (ABVD). Responder and non-responder lesions were identified on interim-FDG-PET/CT performed after two ABVD. We used Multivariate Generalized Estimating Equations model to assess statistical association between being-responder and baseline-Maximum Standard Uptake Value (SUVmax), baseline and interim-Apparent Diffusion Coefficient (ADC) and size, ADC and size changes during chemotherapy, site of disease, bulky, and stage. Results 10/41 (24%) patients were positive on interim-FDG-PET/CT. The interim-FDG-PET/CT positivity was associated with worse cumulative survival rate at 24 months in comparison to interim-FDG-PET/CT negativity (P Conclusions Interim-ADC is helpful for identifying non-responder lesions, while size changes are not useful. Baseline-SUVmax and ADC have no predictive role. Bulky is the most useful imaging parameter to predict suboptimal response to chemotherapy.