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01.07.2014 | Original Article | Ausgabe 7/2014

European Journal of Nuclear Medicine and Molecular Imaging 7/2014

qPET – a quantitative extension of the Deauville scale to assess response in interim FDG-PET scans in lymphoma

Zeitschrift:
European Journal of Nuclear Medicine and Molecular Imaging > Ausgabe 7/2014
Autoren:
Dirk Hasenclever, Lars Kurch, Christine Mauz-Körholz, Andreas Elsner, Thomas Georgi, Hamish Wallace, Judith Landman-Parker, Angelina Moryl-Bujakowska, Michaela Cepelová, Jonas Karlén, Ana Álvarez Fernández-Teijeiro, Andishe Attarbaschi, Alexander Fosså, Jane Pears, Andrea Hraskova, Eva Bergsträsser, Auke Beishuizen, Anne Uyttebroeck, Eckhard Schomerus, Osama Sabri, Dieter Körholz, Regine Kluge
Wichtige Hinweise
Dirk Hasenclever and Lars Kurch contributed equally.

Research Support

Deutsche Krebshilfe e.V. (No. 106161)
EAHC – European Agency for Health and Consumers
Peter-Escher-Stiftung für krebskranke Kinder
Hermes Medical Solutions AB

Abstract

Background

Interim FDG-PET is used for treatment tailoring in lymphoma. Deauville response criteria consist of five ordinal categories based on visual comparison of residual tumor uptake to physiological reference uptakes. However, PET-response is a continuum and visual assessments can be distorted by optical illusions.

Objectives

With a novel semi-automatic quantification tool we eliminate optical illusions and extend the Deauville score to a continuous scale.

Patients and methods

SUVpeak of residual tumors and average uptake of the liver is measured with standardized volumes of interest. The qPET value is the quotient of these measurements. Deauville scores and qPET-values were determined in 898 pediatric Hodgkin’s lymphoma patients after two OEPA chemotherapy cycles.

Results

Deauville categories translate to thresholds on the qPET scale: Categories 3, 4, 5 correspond to qPET values of 0.95, 1.3 and 2.0, respectively. The distribution of qPET values is unimodal with a peak representing metabolically normal responses and a tail of clearly abnormal outliers. In our patients, the peak is at qPET = 0.95 coinciding with the border between Deauville 2 and 3. qPET cut values of 1.3 or 2 (determined by fitting mixture models) select abnormal metabolic responses with high sensitivity, respectively, specificity.

Conclusions

qPET methodology provides semi-automatic quantification for interim FDG-PET response in lymphoma extending ordinal Deauville scoring to a continuous scale. Deauville categories correspond to certain qPET cut values. Thresholds between normal and abnormal response can be derived from the qPET-distribution without need for follow-up data. In our patients, qPET < 1.3 excludes abnormal response with high sensitivity.

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