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01.06.2014 | Original Article | Ausgabe 6/2014

European Journal of Nuclear Medicine and Molecular Imaging 6/2014

Metabolic tumour volumes measured at staging in lymphoma: methodological evaluation on phantom experiments and patients

Zeitschrift:
European Journal of Nuclear Medicine and Molecular Imaging > Ausgabe 6/2014
Autoren:
Michel Meignan, Myriam Sasanelli, René Olivier Casasnovas, Stefano Luminari, Federica Fioroni, Chiara Coriani, Helene Masset, Emmanuel Itti, Paolo G. Gobbi, Francesco Merli, Annibale Versari
Wichtige Hinweise
This study was presented in part at the 4th International Workshop on PET in Lymphoma, Menton 2012.

Abstract

Purpose

The presence of a bulky tumour at staging on CT is an independent prognostic factor in malignant lymphomas. However, its prognostic value is limited in diffuse disease. Total metabolic tumour volume (TMTV) determined on 18F-FDG PET/CT could give a better evaluation of the total tumour burden and may help patient stratification. Different methods of TMTV measurement established in phantoms simulating lymphoma tumours were investigated and validated in 40 patients with Hodgkin lymphoma and diffuse large B-cell lymphoma.

Methods

Data were processed by two nuclear medicine physicians in Reggio Emilia and Créteil. Nineteen phantoms filled with 18F-saline were scanned; these comprised spherical or irregular volumes from 0.5 to 650 cm3 with tumour-to-background ratios from 1.65 to 40. Volumes were measured with different SUVmax thresholds. In patients, TMTV was measured on PET at staging by two methods: volumes of individual lesions were measured using a fixed 41 % SUVmax threshold (TMTV41) and a variable visually adjusted SUVmax threshold (TMTVvar).

Results

In phantoms, the 41 % threshold gave the best concordance between measured and actual volumes. Interobserver agreement was almost perfect. In patients, the agreement between the reviewers for TMTV41 measurement was substantial (ρ c = 0.986, CI 0.97 – 0.99) and the difference between the means was not significant (212 ± 218 cm3 for Créteil vs. 206 ± 219 cm3 for Reggio Emilia, P = 0.65). By contrast the agreement was poor for TMTVvar. There was a significant direct correlation between TMTV41 and normalized LDH (r = 0.652, CI 0.42 – 0.8, P <0.001). Higher disease stages and bulky tumour were associated with higher TMTV41, but high TMTV41 could be found in patients with stage 1/2 or nonbulky tumour.

Conclusion

Measurement of baseline TMTV in lymphoma using a fixed 41% SUVmax threshold is reproducible and correlates with the other parameters for tumour mass evaluation. It should be evaluated in prospective studies.

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