scholarly journals Aberrant patterns of PET response during treatment for DLBCL patients with MYC gene rearrangements

2021 ◽  
Author(s):  
J. J. Eertink ◽  
A. I. J. Arens ◽  
J. E. Huijbregts ◽  
F. Celik ◽  
B. de Keizer ◽  
...  
Keyword(s):  
B Cell Lymphoma ◽  
Metabolic Tumor Volume ◽  
Gene Rearrangements ◽  
Predictive Values ◽  
Interim Pet ◽  
Standardized Uptake Values ◽  
Positron Emission ◽  
Pet Ct ◽  
Myc Gene ◽  
Pet Scans

Abstract Purpose MYC gene rearrangements in diffuse large B-cell lymphoma (DLBCL) patients are associated with poor prognosis. Our aim was to compare patterns of 2[18F]fluoro-2-deoxy-D-glucose positron emission tomography computed tomography (PET/CT) response in MYC + and MYC- DLBCL patients. Methods Interim PET/CT (I-PET) and end of treatment PET/CT (EoT-PET) scans of 81 MYC + and 129 MYC- DLBCL patients from 2 HOVON trials were reviewed using the Deauville 5-point scale (DS). DS1-3 was regarded as negative and DS4-5 as positive. Standardized uptake values (SUV) and metabolic tumor volume (MTV) were quantified at baseline, I-PET, and EoT-PET. Negative (NPV) and positive predictive values (PPV) were calculated using 2-year overall survival. Results MYC + DLBCL patients had significantly more positive EoT-PET scans than MYC- patients (32.5 vs 15.7%, p = 0.004). I-PET positivity rates were comparable (28.8 vs 23.8%). In MYC + patients 23.2% of the I-PET negative patients converted to positive at EoT-PET, vs only 2% for the MYC- patients (p = 0.002). Nine (34.6%) MYC + DLBCL showed initially uninvolved localizations at EoT-PET, compared to one (5.3%) MYC- patient. A total of 80.8% of EoT-PET positive MYC + patients showed both increased lesional SUV and MTV compared to I-PET. In MYC- patients, 31.6% showed increased SUV and 42.1% showed increased MTV. NPV of I-PET and EoT-PET was high for both MYC subgroups (81.8–94.1%). PPV was highest at EoT-PET for MYC + patients (61.5%). Conclusion MYC + DLBCL patients demonstrate aberrant PET response patterns compared to MYC- patients with more frequent progression during treatment after I-PET negative assessment and new lesions at sites that were not initially involved. Trial registration number and date of registration HOVON-84: EudraCT: 2006–005,174-42, retrospectively registered 01–08-2008. HOVON-130: EudraCT: 2014–002,654-39, registered 26–01-2015

Role of Functional Imaging in the Management of Lymphoma

2011 ◽  
Vol 29 (14) ◽  
pp. 1844-1854 ◽  
Author(s):  
Bruce D. Cheson
Keyword(s):  
Fdg Pet ◽  
B Cell Lymphoma ◽  
Post Treatment ◽  
Metabolic Imaging ◽  
Interim Pet ◽  
Positron Emission ◽  
Pet Ct ◽  
Pretreatment Assessment ◽  
Pet Scans

18-F-fluorodeoxyglucose (FDG) –positron emission tomography (PET), and more recently PET/computed tomography (CT), is the most sensitive and specific imaging technique currently available for patients with lymphoma. Nevertheless, despite being increasingly used in pretreatment assessment, midtreatment evaluation of response, post-treatment restaging, and surveillance during follow-up of patients with lymphoma, its impact on clinical outcome in most clinical situations remains to be confirmed. PET/CT provides its greatest clinical benefit in the post-treatment evaluation of Hodgkin's lymphoma and diffuse large B-cell lymphoma; however, the role of metabolic imaging in other indications and in other histologies remains to be demonstrated. Ongoing risk-adapted studies will hopefully provide evidence for clinical improvement on the basis of altering treatment as a result of interim PET results. Efforts are ongoing to better standardize the conduct and interpretation of FDG-PET scans. FDG-PET has the potential to improve lymphoma patient management; however, its usefulness will likely vary by histology, stage, therapy, and clinical setting.

scholarly journals Interim positron emission tomography scans in diffuse large B-cell lymphoma: an independent expert nuclear medicine evaluation of the Eastern Cooperative Oncology Group E3404 study

Blood ◽  
2010 ◽  
Vol 115 (4) ◽  
pp. 775-777 ◽  
Author(s):  
Sandra J. Horning ◽  
Malik E. Juweid ◽  
Heiko Schöder ◽  
Gregory Wiseman ◽  
Alex McMillan ◽  
...  
Keyword(s):  
Nuclear Medicine ◽  
B Cell ◽  
Cell Lymphoma ◽  
Eastern Cooperative Oncology Group ◽  
B Cell Lymphoma ◽  
Interim Pet ◽  
Large B Cell Lymphoma ◽  
Positron Emission ◽  
Pet Scans ◽  
Large B Cell

AbstractPositive interim positron emission tomography (PET) scans are thought to be associated with inferior outcomes in diffuse large B-cell lymphoma. In the E3404 diffuse large B-cell lymphoma study, PET scans at baseline and after 3 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone were centrally reviewed by a single reader. To determine the reproducibility of interim PET interpretation, an expert panel of 3 external nuclear medicine physicians visually scored baseline and interim PET scans independently and were blinded to clinical information. The binary Eastern Cooperative Oncology Group (ECOG) study criteria were based on modifications of the Harmonization Criteria; the London criteria were also applied. Of 38 interim scans, agreement was complete in 68% and 71% by ECOG and London criteria, respectively. The range of PET+ interim scans was 16% to 34% (P = not significant) by reviewer. Moderate consistency of reviews was observed: κ statistic = 0.445 using ECOG criteria, and κ statistic = 0.502 using London criteria. These data, showing only moderate reproducibility among nuclear medicine experts, indicate the need to standardize PET interpretation in research and practice. This trial was registered at www.clinicaltrials.gov as #NCT00274924.

Final Results of a Prospective Evaluation of the Predictive Value of Interim Positron Emission Tomography in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP-14 (SAKK 38/07)

2015 ◽  
Vol 33 (23) ◽  
pp. 2523-2529 ◽  
Author(s):  
Christoph Mamot ◽  
Dirk Klingbiel ◽  
Felicitas Hitz ◽  
Christoph Renner ◽  
Thomas Pabst ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Ct Scans ◽  
Interim Pet ◽  
Large B Cell Lymphoma ◽  
Positron Emission ◽  
End Of Treatment ◽  
Pet Ct ◽  
Large B Cell

Purpose Our main objective was to prospectively determine the prognostic value of [18F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) after two cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone given every 14 days (R-CHOP-14) under standardized treatment and PET evaluation criteria. Patients and Methods Patients with any stage of diffuse large B-cell lymphoma were treated with six cycles of R-CHOP-14 followed by two cycles of rituximab. PET/CT examinations were performed at baseline, after two cycles (and after four cycles if the patient was PET-positive after two cycles), and at the end of treatment. PET/CT examinations were evaluated locally and by central review. The primary end point was event-free survival at 2 years (2-year EFS). Results Median age of the 138 evaluable patients was 58.5 years with a WHO performance status of 0, 1, or 2 in 56%, 36%, or 8% of the patients, respectively. By local assessment, 83 PET/CT scans (60%) were reported as positive and 55 (40%) as negative after two cycles of R-CHOP-14. Two-year EFS was significantly shorter for PET-positive compared with PET-negative patients (48% v 74%; P = .004). Overall survival at 2 years was not significantly different, with 88% for PET-positive versus 91% for PET-negative patients (P = .46). By using central review and the Deauville criteria, 2-year EFS was 41% versus 76% (P < .001) for patients who had interim PET/CT scans after two cycles of R-CHOP-14 and 24% versus 72% (P < .001) for patients who had PET/CT scans at the end of treatment. Conclusion Our results confirmed that an interim PET/CT scan has limited prognostic value in patients with diffuse large B-cell lymphoma homogeneously treated with six cycles of R-CHOP-14 in a large prospective trial. At this point, interim PET/CT scanning is not ready for clinical use to guide treatment decisions in individual patients.

scholarly journals Novel FAP ligands enable improved imaging contrast in sarcoma patients due to FAPI-PET/CT

2021 ◽  
Author(s):  
Stefan A. Koerber ◽  
R. Finck ◽  
K. Dendl ◽  
M. Uhl ◽  
T. Lindner ◽  
...  
Keyword(s):  
Hybrid Imaging ◽  
Background Activity ◽  
The Novel ◽  
Malignant Tissue ◽  
Primary Tumors ◽  
Aggressive Disease ◽  
Standardized Uptake Values ◽  
Pet Ct ◽  
Pet Scans

Abstract Purpose A high expression of fibroblast activation protein (FAP) was observed in multiple sarcomas, indicating an enormous potential for PET/CT using 68Ga-radiolabeled inhibitors of FAP (FAPI). Therefore, this retrospective study aimed to evaluate the role of the novel hybrid imaging probe for sarcomas as a first clinical evaluation. Methods A cohort of 15 patients underwent 68Ga-FAPI-PET/CT for staging or restaging. The acquisition of PET scans was performed 60 min after administration of 127 to 308 MBq of the tracer. The uptake of 68Ga-FAPI in malignant tissue as well as in healthy organs was quantified by standardized uptake values SUVmean and SUVmax. Results Excellent tumor-to-background ratios (> 7) could be achieved due to low background activity and high SUVmax in primary tumors (median 7.16), local relapses (median 11.47), and metastases (median 6.29). The highest uptake was found for liposarcomas and high-grade disease (range 18.86–33.61). A high SUVmax (> 10) was observed for clinically more aggressive disease. Conclusion These preliminary findings suggest a high potential for the clinical use of 68Ga-FAPI-PET/CT for patients diagnosed with sarcoma.

Total tumor burden in lymphoma – an evolving strong prognostic parameter

2021 ◽  
pp. 20210448
Author(s):  
Michel Meignan ◽  
Anne-Segolene Cottereau ◽  
Lena Specht ◽  
N. George Mikhaeel
Keyword(s):  
Tumor Volume ◽  
Cell Lymphoma ◽  
Strong Predictor ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Risk Groups ◽  
Metabolic Tumor Volume ◽  
Tumor Burden ◽  
Interim Pet ◽  
Fdg Pet Ct

Total metabolic tumor volume (TMTV), a new parameter extracted from baseline FDG-PET/CT, has been recently proposed by several groups as a prognosticator in lymphomas before first-line treatment. TMTV, the sum of the metabolic volume of each lesion, is an index of the metabolically most active part of the tumor and highly correlates with the total tumor burden. TMTV measurement is obtained from PET images processed with different software and techniques, many being now freely available. In the various lymphoma subtypes where it has been measured, such as diffuse large B-cell lymphoma, Hodgkin lymphoma, Follicular Lymphoma, and Peripheral T-cell lymphoma, TMTV has been reported as a strong predictor of outcome (progression-free survival and overall survival) often outperforming the clinical scores, molecular predictors, and results of interim PET. Combined with these scores, TMTV improves the stratification of the populations into risk groups with different outcomes. TMTV cut-off separating the high-risk from the low-risk population impacts the outcome whatever the technique used for its measurement and an international harmonization is ongoing. TMTV is a unique and easy tool that could replace the surrogate of tumor burden included in the prognostic indexes used in lymphoma and help tailor therapy. Other parameters extracted from the baseline PET may give an information on the dissemination of this total tumor volume such as the maximum distance between the lesions. Trials based on TMTV would probably demonstrate its predictive value.

scholarly journals Cervical Cancer: Associations between Metabolic Parameters and Whole Lesion Histogram Analysis Derived from Simultaneous 18F-FDG-PET/MRI

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Hans-Jonas Meyer ◽  
Sandra Purz ◽  
Osama Sabri ◽  
Alexey Surov
Keyword(s):  
Cervical Cancer ◽  
Fdg Pet ◽  
Metabolic Tumor Volume ◽  
Total Lesion Glycolysis ◽  
Histogram Analysis ◽  
Whole Body ◽  
Standardized Uptake Values ◽  
Positron Emission ◽  
18F Fdg ◽  
Magnetic Resonance Imaging Mri

Multimodal imaging has been increasingly used in oncology, especially in cervical cancer. By using a simultaneous positron emission (PET) and magnetic resonance imaging (MRI, PET/MRI) approach, PET and MRI can be obtained at the same time which minimizes motion artefacts and allows an exact imaging fusion, which is especially important in anatomically complex regions like the pelvis. The associations between functional parameters from MRI and 18F-FDG-PET reflecting different tumor aspects are complex with inconclusive results in cervical cancer. The present study correlates histogram analysis and 18F-FDG-PET parameters derived from simultaneous FDG-PET/MRI in cervical cancer. Overall, 18 female patients (age range: 32–79 years) with histopathologically confirmed squamous cell cervical carcinoma were retrospectively enrolled. All 18 patients underwent a whole-body simultaneous 18F-FDG-PET/MRI, including diffusion-weighted imaging (DWI) using b-values 0 and 1000 s/mm2. Apparent diffusion coefficient (ADC) histogram parameters included several percentiles, mean, min, max, mode, median, skewness, kurtosis, and entropy. Furthermore, mean and maximum standardized uptake values (SUVmean and SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were estimated. No statistically significant correlations were observed between SUVmax or SUVmean and ADC histogram parameters. TLG correlated inversely with p25 (r=−0.486,P=0.041), p75 (r=−0.490,P=0.039), p90 (r=−0.513,P=0.029), ADC median (r=−0.497,P=0.036), and ADC mode (r=−0.546,P=0.019). MTV also showed significant correlations with several ADC parameters: mean (r=−0.546,P=0.019), p10 (r=−0.473,P=0.047), p25 (r=−0.569,P=0.014), p75 (r=−0.576,P=0.012), p90 (r=−0.585,P=0.011), ADC median (r=−0.577,P=0.012), and ADC mode (r=−0.597,P=0.009). ADC histogram analysis and volume-based metabolic 18F-FDG-PET parameters are related to each other in cervical cancer.

scholarly journals The utility of pharmacological and radiological interventions to optimize diagnostic information from PET/CT

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
David Dudoignon ◽  
David A. Pattison ◽  
Damien Legallois ◽  
Rodney J. Hicks ◽  
Nicolas Aide
Keyword(s):  
Emission Tomography ◽  
Main Body ◽  
Pharmacological Interventions ◽  
Imaging Protocols ◽  
Affect Image Quality ◽  
Positron Emission ◽  
Pet Ct ◽  
Pictorial Essay ◽  
Pet Probes ◽  
Pet Scans

Abstract Background Positron Emission Tomography with Computed Tomography (PET/CT) is widely used in the assessment of many diseases, particularly including cancer. However, many factors can affect image quality and diagnostic performance of PET scans using FDG or other PET probes. Main body The aim of this pictorial essay is to review PET/CT protocols that can be useful to overcome these confounding factors in routine clinical situations, with a particular focus on pharmacological interventions and problem-oriented CT acquisition protocols. Conclusion Imaging protocols and representative cases will be discussed, in addition to potential contraindications and precautions to be taken.

scholarly journals Interim PET/CT based on visual and semiquantitative analysis predicts survival in patients with diffuse large B‐cell lymphoma

2019 ◽  
Vol 8 (11) ◽  
pp. 5012-5022 ◽  
Author(s):  
Xiaoqian Li ◽  
Xun Sun ◽  
Juan Li ◽  
Zijian Liu ◽  
Mi Mi ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Semiquantitative Analysis ◽  
Interim Pet ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Large B Cell
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