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Pomykala KL, Fendler WP, Vermesh O, Umutlu L, Herrmann K, Seifert R. Molecular Imaging of Lymphoma: Future Directions and Perspectives. Semin Nucl Med 2023; 53:449-456. [PMID: 36344325 DOI: 10.1053/j.semnuclmed.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
More than 250,000 patients die from Hodgkin or non-Hodgkin lymphoma each year. Currently, molecular imaging with 18F-FDG-PET/CT is the standard of care for lymphoma staging and therapy response assessment. In this review, we will briefly summarize the role of molecular imaging for lymphoma diagnosis, staging, outcome prediction, and prognostication. We discuss future directions in response assessment and surveillance with quantitative PET parameters, the utility of interim assessment, and the differences with response assessment to immunomodulatory therapy. Lastly, we will cover innovations in the field regarding novel tracers and artificial intelligence.
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Affiliation(s)
- Kelsey L Pomykala
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
| | - Ophir Vermesh
- Division of Nuclear Medicine in the Department of Radiology at Stanford University, Stanford, CA
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, North Rhine-Westphalia, Germany.
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
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Imaging for diagnosis, staging and response assessment of Hodgkin lymphoma and non-Hodgkin lymphoma. Pediatr Radiol 2019; 49:1545-1564. [PMID: 31620854 DOI: 10.1007/s00247-019-04529-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/14/2019] [Accepted: 09/06/2019] [Indexed: 02/07/2023]
Abstract
Hodgkin lymphoma and non-Hodgkin lymphoma are common malignancies in children and are now highly treatable. Imaging plays a major role in diagnosis, staging and response using conventional CT and MRI and metabolic imaging with positron emission tomography (PET)/CT and PET/MRI. Cross-sectional imaging has replaced staging laparotomy and splenectomy by demonstrating abdominal nodal groups and organ involvement. [F-18]2-fluoro-2-deoxyglucose (FDG) PET provides information on bone marrow involvement, and MRI elucidates details of cortical bone and confirmation of bone marrow involvement. The staging system for Hodgkin lymphoma is the Ann Arbor system with Cotswald modifications and is based on imaging, whereas the non-Hodgkin staging system is the St. Jude Classification by Murphy or the more recent revised International Pediatric Non-Hodgkin Lymphoma Staging System (IPNHLSS). Because all pediatric lymphomas are metabolically FDG-avid and identify all nodal, solid organ, cortical bone and bone marrow disease, staging evaluations require FDG PET as PET/CT or PET/MRI in both Hodgkin and non-Hodgkin lymphoma. Both diseases have in common issues of airway compromise at presentation demonstrated by imaging. Differences exist in that Hodgkin lymphoma has several independent poor prognostic factors seen by imaging such as large mediastinal adenopathy, Stage IV disease, systemic symptoms, pleural effusion and pericardial effusion. Non-Hodgkin lymphoma includes more organ involvement such as renal, ovary, central nervous system and skin. Early or interim PET-negative scans are a reliable indicator of improved clinical outcome and optimize risk-adapted therapy and patient management; imaging may not, however, predict who will relapse. A recent multicenter trial has concluded that it is usually sufficient for pediatric lymphoma at staging and interim assessment to evaluate children with PET imaging from skull base to mid-thigh. Various systems of assessment of presence of disease or response are used, including the Deauville visual scale, where avidity is compared to liver; Lugano, which includes size change as part of response; or quantitative PET, which uses standardized uptake values to define more accurate response. Newer methods of immunotherapy can produce challenges in FDG PET evaluation because of inflammatory changes that may not represent disease.
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FDG-PET/CT at the end of immuno-chemotherapy in follicular lymphoma: the prognostic role of the ratio between target lesion and liver SUV max (rPET). Ann Nucl Med 2018; 32:372-377. [PMID: 29464479 DOI: 10.1007/s12149-018-1243-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/19/2018] [Indexed: 10/18/2022]
Abstract
AIM To retrospectively investigate the prognostic role of the ratio between target lesion and liver SUVmax (rPET) in patients with follicular lymphoma (FL) submitted to FDG-PET/CT at the end of immuno-chemotherapy (PI-PET), and to compare rPET with International Harmonization Project criteria (IHP), Deauville Score (5p-DS) and FL International Prognostic Index at diagnosis (FLIPI). METHODS Eighty-nine patients with FL undergoing PI-PET were evaluated. The receiver operating characteristic (ROC) approach was applied to identify the optimal cut-point of rPET with respect to 5-years progression free survival (PFS). The prognostic significance of rPET was compared with IHP, DS and FLIPI. Positive predictive value (PPV) and negative predictive value (NPV) were calculated using the presence of adverse events as gold standard. RESULTS The ROC analysis for rPET as predictor of progression showed an optimal rPET cut-point of 0.98. Patients with positive values of IHP, DS and rPET had a PFS of 50, 30 and 31%. PPV were of 56, 80 and 80%, NPV of 83, 86 and 88%, respectively. DS and rPET differed only in two patients. FLIPI was not predictive of progression and relapse. CONCLUSIONS rPET is a prognostic factor in patients with FL submitted to PI-PET. Although it has a similar prognostic power as DS, it can have methodological advantages over visual analysis. PI-PET with different evaluation systems has a stronger prognostic power than FLIPI at diagnosis, so it could be useful to identify patients with FL at risk for early relapse after immuno-chemotherapy.
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Measurement uncertainty of lesion and reference mediastinum standardized uptake value in lung cancer. Nucl Med Commun 2017; 38:509-514. [PMID: 28489690 DOI: 10.1097/mnm.0000000000000677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess standardized uptake value (SUV) measurement uncertainty (MU) of lung cancer lesions with uptake greater than mediastinum but less than or equal to the liver and that of the mediastinum blood pool, and to compare lesion SUV with mediastinum SUV by assessing MU of their ratio. PATIENTS AND METHODS Dynamic PET data involving 10 frames were retrospectively analyzed in 10 patients, yielding maximal SUV of 25 lesions (Lesion-SUVmax), 10 mediastinum SUV, either maximal or mean (Med-SUVmax, Med-SUVmean), 25 Rmax ratios (=Lesion-SUVmax/Med-SUVmax), and 25 Rmean ratios (=Lesion-SUVmax/Med-SUVmean). A mean coefficient of variation was calculated for each parameter, leading to relative measurement uncertainty (MUr), respectively. RESULTS MU of Rmax was found to involve both Lesion-SUVmax and Med-SUVmax MU: MUr=33.3-23.3-21.9%, respectively (95% confidence level). No significant difference in MUr was found between Med-SUVmax and Med-SUVmean and between Rmax and Rmean. CONCLUSION Comparison between target lesion SUV and reference mediastinum SUV must take into account SUV MU of both. Therefore, no MU reduction can be expected from using the lesion/mediastinum SUVmax ratio instead of Lesion-SUVmax. Moreover, no MU reduction can be expected from using the mean mediastinum SUV instead of the maximal one.
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Laffon E, Marthan R. FDG PET for therapy monitoring in Hodgkin's and non-Hodgkin's lymphomas: qPET versus rPET. Eur J Nucl Med Mol Imaging 2017; 44:1602-1603. [PMID: 28523358 DOI: 10.1007/s00259-017-3719-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/03/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Eric Laffon
- Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U-1045 and CHU de Bordeaux, F-33000, Bordeaux, France. .,Service de Médecine Nucléaire, Hôpital du Haut-Lévèque, Avenue de Magellan, 33604, Pessac, France.
| | - Roger Marthan
- Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U-1045 and CHU de Bordeaux, F-33000, Bordeaux, France
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Annunziata S, Cuccaro A, Calcagni ML, Hohaus S, Giordano A, Rufini V. Interim FDG-PET/CT in Hodgkin lymphoma: the prognostic role of the ratio between target lesion and liver SUVmax (rPET). Ann Nucl Med 2016; 30:588-92. [PMID: 27246952 DOI: 10.1007/s12149-016-1092-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/18/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the prognostic role of the ratio between target lesion and liver SUVmax (rPET) in patients with Hodgkin lymphoma (HL) undergoing interim FDG-PET/CT and to compare rPET with the 5-point Deauville Score (5p-DS). METHODS Sixty-eight patients with HL undergoing interim FDG-PET/CT after first courses of chemotherapy were evaluated. The receiver operating characteristic (ROC) approach was applied to identify the optimal cutpoint of rPET with respect to progression free survival (PFS). The prognostic significance of rPET was compared with 5p-DS (scores 4 and 5 considered as positive). Positive predictive value (PPV) and negative predictive value (NPV) were calculated using the presence of an adverse event as the gold standard. RESULTS The ROC analysis for rPET as a predictor of progression showed an optimal rPET cutpoint of 1.14. Both 5p-DS and rPET were strong outcome predictors (p < 0.001). Patients with negative 5p-DS and patients with rPET <1.14 had a similar two-year PFS (86 and 87 %, respectively). Patients with a positive 5p-DS had a 2-year PFS of 27 %, while patients with rPET >1.14 had a 2-year PFS of 15 %. 5p-DS and rPET cutoff of 1.14 showed a PPV of 58 versus 70 %, and a NPV of 85 versus 86 %, respectively. CONCLUSIONS rPET could be considered an accurate prognostic factor in patients with HL undergoing interim FDG-PET/CT. Larger prospective studies are needed to confirm these data.
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Affiliation(s)
- Salvatore Annunziata
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Annarosa Cuccaro
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Lucia Calcagni
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Stefan Hohaus
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Giordano
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Vittoria Rufini
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
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Yamamoto S, Huang D, Du L, Korn RL, Jamshidi N, Burnette BL, Kuo MD. Radiogenomic Analysis Demonstrates Associations between (18)F-Fluoro-2-Deoxyglucose PET, Prognosis, and Epithelial-Mesenchymal Transition in Non-Small Cell Lung Cancer. Radiology 2016; 280:261-70. [PMID: 27082783 DOI: 10.1148/radiol.2016160259] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Purpose To investigate whether non-small cell lung cancer (NSCLC) tumors that express high normalized maximum standardized uptake value (SUVmax) are associated with a more epithelial-mesenchymal transition (EMT)-like phenotype. Materials and Methods In this institutional review board-approved study, a public NSCLC data set that contained fluorine 18 ((18)F) fluoro-2-deoxyglucose positron emission tomography (PET) and messenger RNA expression profile data (n = 26) was obtained, and patients were categorized on the basis of measured normalized SUVmax values. Significance analysis of microarrays was then used to create a radiogenomic signature. The prognostic ability of this signature was assessed in a second independent data set that consisted of clinical and messenger RNA expression data (n = 166). Signature concordance with EMT was evaluated by means of validation in a publicly available cell line data set. Finally, by establishing an in vitro EMT lung cancer cell line model, an attempt was made to substantiate the radiogenomic signature with quantitative polymerase chain reaction, and functional assays were performed, including Western blot, cell migration, glucose transporter, and hexokinase assays (paired t test), as well as pharmacologic assays against chemotherapeutic agents (half-maximal effective concentration). Results Differential expression analysis yielded a 14-gene radiogenomic signature (P < .05, false discovery rate [FDR] < 0.20), which was confirmed to have differences in disease-specific survival (log-rank test, P = .01). This signature also significantly overlapped with published EMT cell line gene expression data (P < .05, FDR < 0.20). Finally, an EMT cell line model was established, and cells that had undergone EMT differentially expressed this signature and had significantly different EMT protein expression (P < .05, FDR < 0.20), cell migration, glucose uptake, and hexokinase activity (paired t test, P < .05). Cells that had undergone EMT also had enhanced chemotherapeutic resistance, with a higher half-maximal effective concentration than that of cells that had not undergone EMT (P < .05). Conclusion Integrative radiogenomic analysis demonstrates an association between increased normalized (18)F fluoro-2-deoxyglucose PET SUVmax, outcome, and EMT in NSCLC. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Shota Yamamoto
- From the Department of Radiology, The David Geffen School of Medicine at University of California-Los Angeles (UCLA), 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721 (S.Y., D.H., L.D., N.J., B.L.B., M.D.K.); Department of Bioengineering, UCLA, Los Angeles, Calif (M.D.K.); and Scottsdale Medical Imaging, Scottsdale, Ariz (R.L.K.)
| | - Danshan Huang
- From the Department of Radiology, The David Geffen School of Medicine at University of California-Los Angeles (UCLA), 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721 (S.Y., D.H., L.D., N.J., B.L.B., M.D.K.); Department of Bioengineering, UCLA, Los Angeles, Calif (M.D.K.); and Scottsdale Medical Imaging, Scottsdale, Ariz (R.L.K.)
| | - Liutao Du
- From the Department of Radiology, The David Geffen School of Medicine at University of California-Los Angeles (UCLA), 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721 (S.Y., D.H., L.D., N.J., B.L.B., M.D.K.); Department of Bioengineering, UCLA, Los Angeles, Calif (M.D.K.); and Scottsdale Medical Imaging, Scottsdale, Ariz (R.L.K.)
| | - Ronald L Korn
- From the Department of Radiology, The David Geffen School of Medicine at University of California-Los Angeles (UCLA), 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721 (S.Y., D.H., L.D., N.J., B.L.B., M.D.K.); Department of Bioengineering, UCLA, Los Angeles, Calif (M.D.K.); and Scottsdale Medical Imaging, Scottsdale, Ariz (R.L.K.)
| | - Neema Jamshidi
- From the Department of Radiology, The David Geffen School of Medicine at University of California-Los Angeles (UCLA), 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721 (S.Y., D.H., L.D., N.J., B.L.B., M.D.K.); Department of Bioengineering, UCLA, Los Angeles, Calif (M.D.K.); and Scottsdale Medical Imaging, Scottsdale, Ariz (R.L.K.)
| | - Barry L Burnette
- From the Department of Radiology, The David Geffen School of Medicine at University of California-Los Angeles (UCLA), 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721 (S.Y., D.H., L.D., N.J., B.L.B., M.D.K.); Department of Bioengineering, UCLA, Los Angeles, Calif (M.D.K.); and Scottsdale Medical Imaging, Scottsdale, Ariz (R.L.K.)
| | - Michael D Kuo
- From the Department of Radiology, The David Geffen School of Medicine at University of California-Los Angeles (UCLA), 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721 (S.Y., D.H., L.D., N.J., B.L.B., M.D.K.); Department of Bioengineering, UCLA, Los Angeles, Calif (M.D.K.); and Scottsdale Medical Imaging, Scottsdale, Ariz (R.L.K.)
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Abstract
INTRODUCTION When evaluating response of Hodgkin lymphoma (HL) to chemotherapy on interim (18)F-FDG-PET/CT, physiological liver uptake is used as reference. Hodgkin lymphoma sites with uptake greater than liver are interpreted as positive. We aimed at examining factors that might influence liver uptake as reference organ. METHODS Fifty patients with HL who received baseline (18)F-FDG-PET/CT (PET1) and interim PET (PET2), usually after 2 cycles of adriamycin bleomycin, vinblastine, and dacarbazine chemotherapy, were included retrospectively. SUVmean normalized for body weight (SUVmean) and for lean body mass (SULmean) were obtained from regions of interest in the right lobe of the liver. RESULTS On univariate analysis, liver SUVmean on interim PET increased with increasing body mass index (BMI) (P = 0.0453) and were higher in women (P = 0.0401). These factors remained significant on multivariate analysis (P = 0.009 and P = 0.008, respectively). No significant correlation was found with postinjection delay, blood glucose level, and age. Liver SULmean were not affected by the studied variables. Average liver SUVmean in the 50 patients were similar at baseline and interim PET. In 11 patients (22%), however, there was 30% or greater variation in liver SUVmean between PET1 and PET2. No factors explaining intrapatient variation in hepatic uptake between PET1 and PET2 were found on correlation analysis. CONCLUSION At interim PET in patients with HL, liver SUVmean depends on BMI and sex, but not liver SULmean. Furthermore, our study, conducted with standard clinical procedure, also confirmed the high range of liver uptake values from one patient to another. Caution is required when using liver SUV as reference in patients with high BMI. Intrapatient fluctuation in liver SUVmean should also be expected.
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