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Early ¹⁸F-FDG PET for Prediction of Prognosis in Patients with Diffuse Large B-Cell Lymphoma: SUV-Based Assessment Versus Visual Analysis

¹ Department of Radiology, H. Mondor Hospital, AP-HP/Paris 12 University, Créteil, France; ² Department of Nuclear Medicine, H. Mondor Hospital, AP-HP/Paris 12 University, Créteil, France; ³ Department of Hematology, H. Mondor Hospital, AP-HP/Paris 12 University, Créteil, France; and ⁴ Department of Nuclear Medicine, Tenon Hospital, AP-HP/Paris 6 University, Paris, France

View larger version (61K): [in this window] [in a new window]   FIGURE 1.  Selection of ROIs in 57-y-old patient before chemotherapy. (A) Graded color-scaled parametric analysis applied in reconstructed coronal PET image shows most active tumor in upper abdomen. (B) Transverse PET image with a higher scale reveals celiac tumor (T) with activity profile crossing the hottest point (red spot). (C) Corresponding activity profile in counts-per-pixel. Isocontours are drawn with lower autocontour threshold of 4,500 counts-per-pixel (red isocontour at inset in B). (D) Normal background tissue (N): 2 large ROIs are manually selected on gluteal muscles, avoiding iliac bone marrow activity.

View larger version (13K): [in this window] [in a new window]   FIGURE 2.  Kaplan–Meier plots for estimation of probability of EFS according to PET status at midtherapy. (A) Survival curves based on visual analysis. (B) Survival curves based on percentages of SUVBWmax reduction.

View larger version (86K): [in this window] [in a new window]   FIGURE 3.  A 25-y-old woman with bulky mediastinal uptake on PET1 (A, anterior view), who was interpreted as positive visually on PET2 (B, left anterior oblique view). Two residual foci were diagnosed (arrows), scored as extent = 1, intensity = 1 for retrosternal site and extent = 2, intensity = 1 for left hilar site. However, SUVBWmax reduction was measured at 80.7%—that is, above the cutoff value of 65.7%, indicating good early response. Patient remained in complete remission after 36 mo of follow-up.