FDG PET/CT for evaluating systemic arterial inflammation induced by anthracycline-based chemotherapy of Hodgkin lymphoma

Abstract

To evaluate arterial fluorodeoxyglucose (FDG) uptake as a marker of arterial inflammation in multiple vascular beds in patients treated with anthracycline-based chemotherapy for Hodgkin lymphoma (HL). We used maximum standardized uptake value (SUVmax) and target-to-background ratio (TBR) to quantify arterial FDG uptake in the carotid artery, ascending aorta, abdominal aorta, and femoral artery obtained on positron emission tomography/computed tomography (PET/CT) imaging performed at baseline before chemotherapy and after completion of chemotherapy in patients with HL treated with an anthracycline-containing regimen. We compared the SUVmax and TBR obtained at baseline with that obtained post-chemotherapy for each arterial bed to evaluate the effect of anthracycline-based chemotherapy. We evaluated the effect of cardiovascular risk factors such as human immunodeficiency virus (HIV) infection, smoking, hypertension, and diabetes on the changes in SUVmax and TBR seen in the different arterial beds after anthracycline-based chemotherapy. Fifty-two patients were included with a mean age of 34.56 ± 10.19 years. There were 33 males, and 18 patients were HIV-infected. The mean interval between completion of chemotherapy and follow-up flourine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan was 65 weeks. We found no significant difference in arterial FDG uptake measured by SUVmax and TBR in all arterial beds between the pre- and post-chemotherapy FDG PET/CT. There was no significant impact of HIV infection, smoking, and hypertension on the changes in arterial FDG uptake following treatment with anthracycline-based chemotherapy. In patients with HL who were treated with anthracycline-based chemotherapy, we found no significant increase in arterial inflammation measured by FDG PET/CT after an average follow-up period of about 65 weeks since completion of chemotherapy.

Cardiovascular disturbances in COVID-19: an updated review of the pathophysiology and clinical evidence of cardiovascular damage induced by SARS-CoV-2

“…They may have contributed to the lack of significant difference in the quantified vascular FDG uptake between long COVID patients and controls. Lack of standardization of PET imaging parameters is a known factor implicated in negative studies of vascular inflammation imaging [ 84 ].…”

Arterial effects of anthracycline: structural and inflammatory assessments in non-human primates and lymphoma patients using18F-FDG positron emission tomography

“…Aortic stiffening has been demonstrated to occur within 4 months of anthracycline exposure and we wished to examine this ‘high risk’ period 34 . A previous smaller retrospective study examined arterial 18 F-FDG PET/CT in 52 patients following anthracycline treatment for Hodgkin lymphoma at a mean of 65 weeks and found no difference in large artery TBR 24 . The longer time between completion of chemotherapy and PET scanning meant that evidence of ongoing active inflammation would have been considerably less likely.…”

“…Intra-and interobserver variability was assessed by the intra-class correlation (ICC) coefficient. Based on prior studies using change in mean TBRmax as a primary outcome, a sample size of 101 patients was needed to detect a 10-15% difference between groups with a power of 85% and significance of 5%, assuming a baseline TBRmax of 1.57  0.42 and a SD of change in TBRmax of 0.4 [23][24][25] . A p value <0.05 was taken to represent statistical significance.…”

Effects of Chemotherapy on Aortic 18-Fluorodeoxyglucose Uptake in Patients With Hodgkin and Non-Hodgkin Lymphoma

“…There is only 1 relevant retrospective study investigating aortic wall inflammation in patients with HL. Specifically, Lawal et al 21 assessed 18 FDG PET/CT scans of patients with HL before and after chemotherapy completion (first-line chemotherapy; average time interval until the second scan was 65 weeks). In this study, patients that were assessed earlier than 24 weeks from chemotherapy completion had significantly lower aortic TBR values in all aortic segments than their initial scan.…”