Intra-patient Variability of FDG Standardized Uptake Values in Mediastinal Blood Pool, Liver, and Myocardium during R-CHOP Chemotherapy in Patients with Diffuse Large B-cell Lymphoma

Abstract

Purpose 18F-fluorodeoxyglucose (FDG) PET/CT is useful for staging and evaluating treatment response in patients with diffuse large B-cell lymphoma (DLBCL). A five-point scale model using the mediastinal blood pool (MBP) and liver as references is a recommended method for interpreting treatment response. We evaluated the variability in standardized uptake values (SUVs) of the MBP, liver, and myocardium during chemotherapy in patients with DLBCL. Methods We analyzed 60 patients with DLBCL who received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) treatment and underwent baseline, interim, and final FDG PET/CT scans. The FDG uptakes of lymphoma lesions, MBP, liver, and myocardium were assessed, and changes in the MBP and liver SUV and possible associated factors were evaluated. Results The SUV of the liver did not change significantly during the chemotherapy. However, the SUV mean of MBP showed a significant change though the difference was small (p = 0.019). SUV mean of MBP and liver at baseline and interim scans was significantly lower in patients with advanced Ann Arbor stage on diagnosis. The SUV mean of the MBP and liver was negatively correlated with the volumetric index of lymphoma lesions in baseline scans (r = -0.547, p < 0.001; r = -0.502, p < 0.001). Positive myocardial FDG uptake was more frequently observed in interim and final scans than in the baseline scan, but there was no significant association between the MBP and liver uptake and myocardial uptake. Conclusions The SUV of the liver was not significantly changed during R-CHOP chemotherapy in patients with DLBCL, whereas the MBP SUVof the interim scan decreased slightly. However, the SUV of the reference organs may be affected by tumor burden, and this should be considered when assessing follow-up scans. Although myocardial FDG uptake was more frequently observed after R-CHOP chemotherapy, it did not affect the SUV of the MBP and liver.

Usefulness of Topically Applied Sensors to Assess the Quality of 18F-FDG Injections and Validation Against Dynamic Positron Emission Tomography (PET) Images

“…Currently, the effects of infiltrations or stasis on scan interpretation are not yet understood. While it may be possible to correct for these administration issues through SUV normalization, the effects from an infiltration or stasis on SUV values of reference organs or the mediastinum blood pool are unknown ( 30 ). Therefore, further studies that assess the significance of the infiltration effects and how they correlate to current correction methods (e.g., normalization to blood pool or reference organ SUV) are needed.…”

Prognostic Value of Baseline18F-Fluorodeoxyglucose PET/CT in Patients with Multiple Myeloma: A Multicenter Cohort Study

“…The parameter enables measurement of tumor burden more precisely than simple visual analysis. However, SUVmax is affected by various factors including patient condition, noise, reconstruction algorithm, smoothing, and even the voxel size along with the model of the PET/CT scanner ( 22 23 ). Consequently, in a retrospective multicenter study with variable scanners and imaging protocols, SUVmax cannot guarantee consistent results between the hospitals.…”

Optimisation of BMI-based Images for Overweight and Obese Patients – Implications on Image Quality, Quantitative Accuracy and Radiation Dose in Whole Body 18F-FDG PET/CT Imaging.

“…The improvement in SNR was found to be statistically significant (p < 0.004). Moreover, in terms of quantification accuracy, the optimal reconstruction provided lower SUVmax and SUVpeak in the liver, which considered as reference regions [29,30,35], by approximately 19% and 11% in overweight and obese patients, respectively, compared to BW-based images. The differences in SUVmax were found to be statistically significant (p < 0.013) but not statistically significant (p > 0.6) in SUVpeak.…”

“…The SNR was calculated in volume of interest (VOIs) drawn in the liver on both BW-based and BMI-based images. The semi-quantitative SUVmax and SUVpeak measurements were made in the mediastinal blood pool and liver; used as reference regions as in previous studies [29,30,35]. The VOIs in both regions are illustrated on the PET axial slices in figure 3.…”