Korean J Radiol.  2010 Jun;11(3):327-332. 10.3348/kjr.2010.11.3.327.

Cellular Density Evaluation for Malignant Lymphoma Using Equivalent Cross-Relaxation Rate Imaging - Initial Experience

• Nishiofuku H
• Matsushima S
• Inaba Y
• Yamaura H
• Sato Y
• Morishima
• Kichikawa

• KMID: 946273
• DOI: http://doi.org/10.3348/kjr.2010.11.3.327

Abstract

OBJECTIVE
Equivalent cross-relaxation rate (ECR) imaging is an MRI technique used to evaluate quantitatively a change in the protein-water interaction. We aimed to evaluate retrospectively the usefulness of ECR imaging for the histologic classification of malignant lymphoma (ML). MATERIALS AND METHODS: Institutional Review Board approval was obtained and all patients provided informed consent. The study subjects included 15 patients with untreated ML who were histologically diagnosed with follicular lymphoma (FL; n = 8) or diffuse large B-cell lymphoma (DLBCL; n = 7). All patients underwent ECR imaging and the offset frequency was set at 7 ppm. RESULTS: The median ECR values were 71% (range; 60.7 to 75.5) in FL and 54% (50.8 to 59.4) in DLBCL (p = 0.001). The median cellular density was 1.5 +/- 0.17 x 10(6) / mm2 in FL and 1.0 +/- 0.70 x 10(6) / mm2 in DLBCL (p = 0.001). The correlation coefficient between the ECR values and cellular density in ML was 0.88 (p = 0.001). In FL and DLBCL, assuming ECR value cut-off points of 60%, both sensitivity and specificity were 100%. CONCLUSION: A strong correlation between ECR and cellular density in ML is demonstrated and the ECR may be a useful technique to differentiate between FL and DLBCL.

Keyword

Equivalent cross-relaxation rate imaging; Cellular imaging; Malignant lymphoma; Molecular imaging

MeSH Terms

Adult
Aged
Cell Count
Diffusion Magnetic Resonance Imaging/*methods
Female
Humans
Imaging, Three-Dimensional/methods
Lymphoma, Follicular/*pathology
Lymphoma, Large B-Cell, Diffuse/*pathology
Male
Middle Aged
Observer Variation
Retrospective Studies

Figure

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  Fig. 1 Equivalent cross-relaxation rate imaging at frequency offset of 7 ppm. For equivalent cross-relaxation rate imaging, color scale range was set from black to red (0-150). A. Lymph node swelling was seen in paraaortic region, measuring approximately 3×4 cm (white arrow). On equivalent cross-relaxation rate imaging, lymph nodes in follicular lymphoma are yellowish-green. B. Diffusion maximum intensity projection image in follicular lymphoma: enlarged lymph nodes showed high signal intensity. C. Fusion image of equivalent cross-relaxation rate imaging in follicular lymphoma. This area was measured as equivalent cross-relaxation rate value. D. Lymph node swelling is seen in paraaortic region, measuring approximately 4×6 cm (white arrow). Equivalent cross-relaxation rate imaging indicated that lymph nodes in diffuse large B-cell lymphoma are blue. E. Diffusion maximum intensity projection image for diffuse large B-cell lymphoma: enlarged lymph nodes showed high signal intensity. F. Fusion image of equivalent cross-relaxation rate imaging in diffuse large B-cell lymphoma. This area was measured as equivalent cross-relaxation rate value.

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  Fig. 2 Box plots of equivalent cross-relaxation rate data for follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL). Results are expressed as medians and 25-75 percentiles.

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  Fig. 3 Photomicrographs (Hematoxylin & Eosin stain: original magnification ×200) A. Follicular lymphoma: neoplastic cells and normal lymphocytes are intermingled. B. Diffuse large B-cell lymphoma: most cells are neoplastic (approximately 2-3 times size of normal lymphocytes).

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  Fig. 4 Box plots of cellular density data for follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL). Results are expressed as medians and 25-75 percentiles.

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  Fig. 5 Equivalent cross-relaxation rate (ECR) and cellular density. Regression graph: cellular density is plotted along vertical axis, while equivalent cross-relaxation rate is plotted on horizontal axis. Linear relationship was observed with correlation coefficient of 0.88 (Y = 0.028, X-0.49). ML = malignant lymphoma

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