TY - JOUR
T1 - Metabolic tumour volumes measured at staging in lymphoma
T2 - Methodological evaluation on phantom experiments and patients
AU - Meignan, Michel
AU - Sasanelli, Myriam
AU - Casasnovas, René Olivier
AU - Luminari, Stefano
AU - Fioroni, Federica
AU - Coriani, Chiara
AU - Masset, Helene
AU - Itti, Emmanuel
AU - Gobbi, Paolo G.
AU - Merli, Francesco
AU - Versari, Annibale
PY - 2014
Y1 - 2014
N2 - 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 41, 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.
AB - 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 41, 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.
KW - Lymphoma
KW - Metabolic volume
KW - PET/CT
KW - Prognosis
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U2 - 10.1007/s00259-014-2705-y
DO - 10.1007/s00259-014-2705-y
M3 - Article
C2 - 24570094
AN - SCOPUS:84900807519
VL - 41
SP - 1113
EP - 1122
JO - European Journal of Pediatrics
JF - European Journal of Pediatrics
SN - 0340-6199
IS - 6
ER -