Prognostic Significance Of Positron Emission Tomography-Computed Tomography In Patients With Marginal Zone Lymphoma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4324-4324
Author(s):  
Cheolwon Suh ◽  
Ji Hyun Park ◽  
Dok Hyun Yoon ◽  
Jooryung Huh ◽  
Jin Sook Ryu ◽  
...  
Keyword(s):  
Ct Scan ◽  
Marginal Zone ◽  
Prognostic Significance ◽  
Post Treatment ◽  
Emission Tomography ◽  
Ct Scans ◽  
Interim Pet ◽  
Positron Emission ◽  
Pet Ct ◽  
Pet Ct Scan

Abstract Background & Aims 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) scan has been increasingly used for initial staging and response evaluation in patients with lymphomas, and its clinical utility is well established in Hodgkin’s lymphoma (HL) as well as in diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). However, its role remains undetermined in marginal zone lymphomas (MZL), due to its relatively low FDG avidity as well as small numbers of patients in the Western countries although it is the most common type of indolent lymphoma in Korea. Thus, we aimed to assess the prognostic significance of PET-CT scan performed after first-line therapy in patients with MZL. Patients & Methods We retrospectively reviewed the medical records of a total of 194 patients with pathologically confirmed MZL in the Asan Medical Center between February 2003 and February 2011. Post-treatment FDG PET-CT scan was defined as which performed during the periods of 2 to 4 weeks after the completion of chemotherapy or 7 to 9 weeks after radiotherapy. Among them, we identified 32 patients with evaluable pretreatment, interim and post-treatment PET-CT scans who received chemotherapy. We investigated the prognostic significance of maximum standardized uptake value (SUVmax) at pretreatment PET-CT and metabolic complete response (mCR) at post-treatment PET-CT. The log-rank test was used to assess the correlation of event-free survival (EFS) and overall survival (OS) with baseline SUVmax or the presence of mCR. All categorical variables were analyzed using Chi-square test or Fisher’s exact test. Results In a total of analyzable 32 patients, histopathologic subtypes of them were as follow: Mucosa-associated lymphoid tissue (MALT) lymphoma (n=14, 43.8%), nodal MZL (n=17, 53.1%), and splenic MZL (n=1, 3.2%). The median SUVmax in pretreatment PET-CT was 5.3 (range, 1.3 – 18.8). There were no significant associations of SUVmax (cutoff: 5.3) at pretreatment PET-CT to mCR in both post-treatment and interim PET-CT scans (p =0.694 and p=0.723, respectively). However, high SUV group (SUVmax at baseline PET-CT >5.3) showed inferior 5-year EFS and OS to low SUV group (¡Â 5.3) with marginal statistical significicance (p=-0.072 and p=0.101, respectively). With a median follow-up duration of 41 months (range, 9 to 99 months), 5-year OS and EFS rate were 87.9% and 43.9%, respectively. 5-year EFS was significantly superior in patients who attained mCR at post-treatment PET-CT (p =0.010, 55.0% to 0%), and also in interim PET-CT (p=0.007, 70.6% to 13.1%). In addition, patients who attained early mCR showed significantly better 5-year EFS than patients of delayed and never mCR groups (p=0.011, 70.6% to 22.5%, and 0%). Conclusion In our study cohort, patients with low SUVmax (¡Â 5.3) in pretreatment PET-CT showed strong trends of superior EFS and OS. More importantly, early attained mCR and mCR at post-treatment PET-CT were independent predictors of higher 5-year EFS rates. Disclosures: No relevant conflicts of interest to declare.

Prognostic Value of Positron Emission Tomography- Computed Tomography in Patients with Marginal Zone Lymphoma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 5084-5084
Author(s):  
Ji Hyun Park ◽  
Dok Hyun Yoon ◽  
Sun Mok Kim ◽  
Jae-Cheol Jo ◽  
Jeongseok Kim ◽  
...  
Keyword(s):  
Ct Scan ◽  
Marginal Zone ◽  
Prognostic Significance ◽  
Marginal Zone Lymphoma ◽  
Post Treatment ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

Abstract Abstract 5084 Background & Aims 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) scan has been increasingly used for initial staging and response evaluation in patients with lymphomas, and its clinical utility is well established in diffuse large B-cell lymphoma as well as Hodgkin lymphoma. However, its role remains undetermined in marginal zone lymphomas (MZL), most common type of indolent lymphoma in Korea, due to its relatively low FDG avidity. Thus, we aimed to assess the prognostic significance of PET-CT scan in patients with MZL. Patients & methods We retrospectively reviewed the medical records of a total of 194 patients with pathologically confirmed MZL in the Asan Medical Center between February 2003 and February 2011. Post-treatment FDG PET-CT scan was defined as which performed during the periods of 2 to 4 weeks after the completion of induction chemotherapy or 7 to 9 weeks after radiotherapy. [a4] Among them, both baseline and post-treatment FDG PET-CT scans were performed in 64 patients. We investigated the prognostic significance of maximum standardized uptake value (SUVmax) at baseline PET-CT and metabolic complete response. Metabolic compete response (mCR) was defined as no pathologic FDG uptake at any site in post-treatment PET-CT scan. The log-rank test was used to assess the correlation of progression-free survival (PFS) and overall survival (OS) with baseline SUVmax or the presence of mCR. Results In a total of analyzable 64 patients, histopathologic subtypes of them were as follow: extranodal marginal zone lymphoma (ENMZL=38, 59. 4%) including mucosa-associated lymphoid tissue (MALT) (n=35, 54. 7%) and bronchus-associated lymphoid tissue (BALT) (n=3, 4. 7%) lymphoma, nodal MZL (n=25, 39. 0%), splenic MZL (n=1, 1. 6%). The median SUVmax in baseline PET-CT was 4. 9 (range, 1. 3 – 18. 8). There were no significant associations of baseline SUVmax (cutoff: 5) to mCR at post-treatment PET-CT scan or survival outcomes. Patients group with high SUVmax (SUVmax >5. 0) showed mCR rate of 72. 7 %, and patients low SUVmax (SUVmax ° Â 5) showed mCR rate of 67. 7%, respectively. (p=0. 786). With a median follow-up duration of 46 monthss (range, 13 to 109 months), 5-year OS and PFS rate were 91% and 71%, respectively. 5-year PFS rate (76% vs. 62%, p=0. 27) did not differ between complete metabolic responders and incomplete responders. However, complete metabolic responders showed higher 5 year OS rate compared with incomplete responders (93% vs. 86%, p=0. 43) although statistical significance was not secured. Conclusion In the study cohort, baseline SUVmax was not a significant predictor of mCR, PFS nor OS. However, the patients achieved mCR at the end of induction treatment seemed to have superior survival rates than incomplete responders, which warrants further investigation. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Additive value of positron emission tomography/computed tomography scan for detection of aortic tube graft infection: a case report

2020 ◽  
Author(s):  
Farnoosh Larti ◽  
Mohammad Amin Khadembashiri ◽  
Mehrshad Abbasi ◽  
Alborz Sherafati
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Diagnostic Accuracy ◽  
Ct Scan ◽  
Graft Infection ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
History Of ◽  
Pet Ct Scan

Abstract Background Diagnosis of aortic graft infection is challenging, and delayed diagnosis is associated with poor prognosis. Positron emission tomography/computed tomography (PET/CT) has improved diagnostic accuracy. Case summary A patient with a history of congenital heart disease was admitted due to fever. He had a history of four cardiac surgeries, including the Bentall procedure for endocarditis. Blood cultures were negative. A semi-mobile mass was detected in the distal portion of the aortic tube graft in echocardiography. PET/CT scan was used to confirm tube graft infection and to support proceeding to cardiac surgery. Discussion Using multimodality imaging, including PET/CT scan in combination with echocardiography, can improve diagnostic accuracy for the detection of aortic tube graft infection, infection of prosthetic valves, or intra-cardiac devices, especially in high-risk surgical cases.

scholarly journals Risk Stratification Integrating Deauville Score on Interim PET-CT Scan and Baseline International Prognostic Index in Diffuse Large B-Cell Lymphoma Patients

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1698-1698
Author(s):  
Ho-Young Yhim ◽  
Sung Kyun Yim ◽  
So Yeon Jeon ◽  
Yeon-Hee Han ◽  
Myung-Hee Sohn ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Ct Scan ◽  
Treatment Outcomes ◽  
B Cell Lymphoma ◽  
Low Risk ◽  
Ct Scans ◽  
Newly Diagnosed ◽  
Interim Pet ◽  
Pet Ct ◽  
Pet Ct Scan

Abstract Background Interim 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scan may predict outcomes in patients with diffuse large B-cell lymphoma (DLBCL). However, overall accuracy in predicting treatment outcomes on adopting 5-point Deauville score (DS) was considerably low in DLBCL because of mainly low positive predictive value of interim PET-CT scans. This suggested that additional tool might be needed to more accurately predict treatment outcomes. International prognostic index (IPI) was greatly associated with outcomes for DLBCL and considered to reflect biologic aggressiveness of DLBCL. Thus, we hypothesized that combined assessments using DS on interim PET-CT scan and baseline IPI might improve the prediction of treatment outcomes in DLBCL patients. In this study, we aimed to establish the risk predicting model integrating DS on interim PET-CT as an estimate of early metabolic response and baseline IPI as a predictor of biologic aggressiveness in patients with newly diagnosed DLBCL. Methods In this retrospective cohort study, we consecutively enrolled patients with newly diagnosed DLBCL. Patients were eligible if they were histologically confirmed with DLBCL from Jan 2007 to June 2016, received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), and had PET-CT scan data at baseline and at interim after 3 cycles of R-CHOP. Primary CNS or transformed DLBCLs were excluded. Interim PET-CT was assessed using 5-point DS and four point or higher was regarded as positive. All PET-CT scans were assessed by 2 experienced nuclear medicine physicians, who were masked to treatment outcomes of the patients. Discrepant interpretations between 2 nuclear medicine physicians were resolved by consensus through mutual discussion. Results A total of 316 patients were screened for eligibility. Ninety-six patients were excluded from the analysis due to following reasons: unavailable baseline (n=9) or interim PET-CT scans (n=48), early death before interim PET-CT (n=16), Primary CNS or transformed DLBCLs (n=15), and insufficient medical records (n=8). Thus, 220 patients were analyzed. Median age was 64 years (range, 19-87) and 132 (60%) were male. Based on the IPI risk, patients were classified as the low or low-intermediate (LI; N=126, 57%), and high-intermediate (HI) or high (N=94, 43%) groups. Interim DS was determined as 1 (n=67, 30.5%), 2 (n=65, 29.5%), 3 (n=39, 17.7%), 4 (n=36, 16.4%), and 5 (n=13, 5.9%). With a median follow-up of 56.6 months (IQR 36.0-71.8), 5-year progression-free survival (PFS) rate was 65.2% (95% CI, 58.1-72.3) and overall survival (OS) rate was 69.9% (95% CI, 63.2-76.6). Interim DS (1-3 vs 4-5) and the IPI (low-LI vs HI-high) were independently associated with PFS (for interim DS of 4-5, hazard ratio [HR], 2.96 [95% CI, 1.83-4.78], P < 0.001; for HI-high IPI, HR, 4.84 [2.84-8.24], P < 0.001) and OS (for interim DS of 4-5, HR, 2.98 [1.79-4.98], P < 0.001; for HI-high IPI, HR, 5.75 [3.14-10.51], P < 0.001) in the multivariate analysis. We stratified patients into 3 groups based on the risk of progression: Low (low-LI IPI and interim DS 1-3), Intermediate (low-LI IPI with interim DS 4-5, or HI-high IPI with interim DS 1-3), and High (HI-high IPI and interim DS 4-5) risk groups. The risk stratification model showed a significant association with PFS (for low risk vs intermediate risk, HR 3.98 [95% CI, 2.10-7.54], P<0.001; for low risk vs high risk, HR 13.97 [7.02-27.83], P<0.001; Fig 1A) and OS (for low risk vs intermediate risk, HR 4.14 [2.01-8.54], P<0.001; for low risk vs high risk, HR 16.05 [7.59-33.94], P<0.001; Fig 1B). Conclusion Combining interim DS with baseline IPI can improve risk stratification in patients with newly diagnosed DLBCL. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Prognostic Value of Interim and End of Treatment FDG-PET/CT Scan Results in Adult Patients with Burkitt Lymphoma - a Retrospective Analysis of a Single Center Cohort

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5025-5025
Author(s):  
Eldar Priel ◽  
Meirav Kedmi ◽  
Tima Davidson ◽  
Ginette Schiby ◽  
Elena Ribakovsky ◽  
...  
Keyword(s):  
Ct Scan ◽  
Fdg Pet ◽  
Adult Patients ◽  
Ct Scans ◽  
Survival Outcomes ◽  
Interim Pet ◽  
End Of Treatment ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

Abstract Introduction: End of treatment FDG-PET/CT activity is a powerful predictor of survival outcome in patients with Hodgkin, Diffuse large B cell and Follicular lymphomas. The predictive value of interim PET/CT scan on survival in Hodgkin lymphoma is also well established. To date, there are limited data regarding the prognostic significance of interim and end of treatment FDG-PET/scan results in adult patients with Burkitt lymphoma (BL), mainly due to the rarity of this entity. In this single-center retrospective study we analyzed the survival outcomes of patients with BL according to the findings on interim and end of treatment FDG-PET/CT scans using the Deauville criteria. Methods: We thoroughly reviewed the clinical records of all BL patients who were treated in our medical center between 2005-2014. Thirty three patients and 104 scans were included in our final analysis. Interim PET/CT scan was performed before starting the 3rd cycle of the therapy. PET/CT scans were scored as positive or negative based on the five-point scale: scores 1-3 represented complete metabolic response (CMR) and scores 4-5 defined persistent or progressive disease. Response and survival outcomes were defined according to the Lugano Classification. Survival was calculated with the Kaplan-Meier method and survival comparison was analyzed with the Log-Rank test. Results: Twenty four (73 %) were males and median age was 48 years (22-78). Two patients were HIV positive. Twenty four patients (73%) had stage 3 or 4 disease and 25 patients (76%) had high-intermediate or high risk disease according to the International Prognostic Index. All patients received intensive regimens, and the majority of them (78%) were treated according to the GMALL-B-ALL/NHL2002 protocol. Rituximab was part of treatment in 28 (85%) patients. After a median follow-up of 1.92 years (yrs) (0.08-9.58), 7 patients (21%) have died: six due to advanced BL and one from treatment related toxicity. The overall (OS) and progression-free survival (PFS) at 3-yrs for all patients were 76% and 70%, respectively. Importantly, OS was predicted by the results of end of treatment PET/CT scans: patients in CMR (n=21) had OS of 90% while those with positive PET/CT (n=5) had OS of 30% at 3 years (Figure 1, p=0.001). Early-interim PET/CT results did not predict either PFS or OS at 3 years (OS - 85% for patients in CMR and 60% for patients with positive PET, p=0.27). Conclusions: The current retrospective study indicates that adult patients with BL, who receive rituximab-based intensive regimens, such as the GMALL-B-ALL/NHL2002 protocol, have a favorable outcome. End of treatment PET activity strongly predicted survival outcomes while interim PET result did not correlate with prognosis. Based on our data, it appears that changing treatment in adult patients with BL only on the basis of interim PET/CT results is not advised, unless there is clear evidence of progression. *Authors EP, MK & TD equally contributed to this study. Disclosures No relevant conflicts of interest to declare.

scholarly journals Classical Hodgkin Lymphoma; Real-World Observations from Physicians, Patients, and Caregivers on the Disease and Its Treatment (CONNECT): Observations of Physicians on Treatment and Interim PET-Adapted Regimens

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1390-1390
Author(s):  
Susan K. Parsons ◽  
Kristina S. Yu ◽  
Nicholas Liu ◽  
Supriya Kumar ◽  
Michelle A. Fanale ◽  
...  
Keyword(s):  
Ct Scan ◽  
Stage Iii ◽  
Ct Scans ◽  
Classical Hodgkin Lymphoma ◽  
Publicly Traded ◽  
Nccn Guidelines ◽  
Interim Pet ◽  
Deauville Score ◽  
Pet Ct ◽  
Pet Ct Scan

Abstract Background Current NCCN guidelines recommend 1 of 3 first-line (1L) regimens for stage III or IV classical Hodgkin lymphoma (cHL): ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), A+AVD (brentuximab vedotin, doxorubicin, vinblastine, dacarbazine), or escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone); preferred regimens vary by region (e.g., North America vs Europe). The NCCN recommends positron emission tomography/computerized tomography (PET/CT) imaging after cycle 2 (interim PET2) to guide ABVD escalation or de-escalation. We surveyed physicians on their cHL treatment decision-making process and how PET/CT scan access, reimbursement, and comprehension influence their choices as part of CONNECT, the first real-world survey of physicians, patients, and caregivers in cHL. Methods Medical oncologists, hematologist/oncologists, or hematologists who treat cHL were invited to participate in an Institutional Review Board-approved, 30-minute online anonymous survey. Eligible participants had ≥2 years of practice experience in the United States (US) and treated ≥1 adult (aged ≥18 years) with stage III or IV cHL and ≥1 adult with cHL in the 1L setting within the prior 12 months. Surveys were completed from October 19, 2020-November 16, 2020. Results Of 301 participating physicians, 80% were hematologist/oncologists with a median practice duration of 15 years; 62% practiced in community and 38% in academic settings. Participants were located in the US (South, 34%; Northeast, 26%; West, 21%; Midwest, 20%) and spent 90% of their professional time in direct patient care. In the preceding 12 months, participants treated a median (interquartile range) of 16 (7-40) patients with active cHL (stage III [median], 4; stage IV, 5) and 15 (8-40) cHL survivors. When treating cHL, 88% of participants reported giving NCCN guidelines somewhat/significant consideration. Overall, 94% of participants (n=284) reported using a PET/CT combined scan to diagnose/stage cHL, in line with current guideline recommendations. Of these participants, 97% reported typically getting an interim PET/CT scan for stage III or IV cHL with 65% typically getting the scan after cycle 2 (Figure A). Participants reported both escalating and de-escalating treatment based on interim PET/CT results (Figure B) with 61% making decisions after cycle 2. Of participants using a PET/CT scan, 42% reported receiving both a Deauville score and a standardized uptake value (SUV; Figure C) with 62% of participants noting that the Deauville score was the primary system used for reviewing PET/CT results (Figure D). However, 19% of participants reported challenges interpreting PET/CT results. Among participants using a Deauville score (n=209), consensus was limited on what defined a positive scan (≥3, 44%; ≥4, 37%). Challenges obtaining PET/CT scans were reported by 16% of participants using PET/CT scans. However, despite not reporting challenges 55% of participants on average were unable to obtain a PET/CT scan 20% of the time. Of participants using PET/CT scans, 86% reported typically receiving results within 2 business days and 14% within 3-5 business days. Twenty-one percent of participants reported that delays in PET/CT results affected their ability to use a PET-adaptive approach. Forty-nine percent of those using PET/CT scans reported increased difficulty in PET/CT access for stage III or IV cHL due to lack of insurance coverage. In absence of a PET/CT scan, 36% of participants reported using an interim biopsy and 63% an interim CT scan to inform treatment choices. Among all participants, 36% reported increased difficulty in getting patients with cHL access to PET/CT scans due to COVID-19. Conclusions Although participants consider NCCN guidelines when treating cHL, interim PET scans are not universally obtained after cycle 2 for stage III or IV cHL, with 65% of participants who use PET/CT scans obtaining an interim PET scan after cycle 2 for stage III or IV cHL. When PET/CT scans are obtained, Deauville scores are commonly provided; however, there is variability in what is termed a positive or negative Deauville score. Challenges in obtaining PET/CT scans, with increased difficulty during COVID-19, were reported. Also, there are other barriers, such as lack of insurance, that may prohibit the optimal adherence to guidelines on interim PET/CT utilization. Figure 1 Figure 1. Disclosures Parsons: SeaGen: Consultancy. Yu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Liu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Kumar: Seagen, Inc: Consultancy. Fanale: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Flora: Seagen, Inc: Research Funding.

scholarly journals Prevalence of Clinically Significant Extraosseous Findings on Unenhanced CT Portions of18F-Fluoride PET/CT Bone Scans

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Chao-Jung Chen ◽  
Shih-Ya Ma
Keyword(s):  
Pulmonary Metastases ◽  
Emission Tomography ◽  
Ct Scans ◽  
Unenhanced Ct ◽  
Positron Emission ◽  
Pet Ct ◽  
Clinically Significant ◽  
Bone Scans ◽  
Pet Ct Scan ◽  
Ct Studies

Objective. Due to the frequently interrupted supply of99mTc-methylene diphosphonate, the use of18F-fluoride positron emission tomography (PET)/computed tomography (CT) has become more popular. The study aims to determine the percentage of extraosseous findings from the unenhanced CT portion of18F-fluoride PET/CT scans.Materials and Methods. We retrospectively collected18F-fluoride PET/CT studies between March 2010 and February 2011. The unenhanced CT portions of18F-fluoride PET/CT were reviewed for each patient. Significant extraosseous findings related to malignancy from the unenhanced CT were recorded.Results. A total of 158 patients (110 females, 48 males) were included in the study. Clinically significant extraosseous findings from the unenhanced CT were found in 43 patients (27.2%). Previously unknown extraosseous findings were identified in 17 patients (10.8%) after a review of the18F-fluoride PET/CT scan results. Most of the extraosseous findings were small pulmonary metastases or enlarged metastatic lymph nodes.Conclusion. It is not rare to identify new clinically significant extraosseous findings from the unenhanced CT of18F-fluoride PET/CT studies. Therefore the clinical management of patients may be altered by the results, and a careful review of the unenhanced CT portion of18F-fluoride PET/CT is mandatory.

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