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Kewitz-Hempel S, Kurch L, Cepelova M, Volkmer I, Sauerbrey A, Conrad E, Knirsch S, Pöpperl G, Steinbach D, Beer AJ, Kramm CM, Sahlmann CO, Erdlenbruch B, Reinbold WD, Odparlik A, Sabri O, Kluge R, Staege MS. Impact of rs12917 MGMT Polymorphism on [ 18F]FDG-PET Response in Pediatric Hodgkin Lymphoma (PHL). Mol Imaging Biol 2019; 21:1182-1191. [PMID: 30945122 DOI: 10.1007/s11307-019-01350-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The enzyme O6-methylguanine-DNA methyltransferase (MGMT) is an important component of the DNA repair machinery. MGMT removes O6-methylguanine from the DNA by transferring the methyl group to a cysteine residue in its active site. Recently, we detected the single nucleotide polymorphism (SNP) rs12917 (C/T) in the MGMT sequence adjacent to the active site in Hodgkin lymphoma (HL) cell line KM-H2. We now investigated whether this SNP is also present in other HL cell lines and patient samples. Furthermore, we asked whether this SNP might have an impact on metabolic response in 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography ([18F]FDG-PET), and on overall treatment outcome based on follow-up intervals of at least 34 months. PROCEDURES We determined the frequency of this MGMT polymorphism in 5 HL cell lines and in 29 pediatric HL (PHL) patients. The patient cohort included 17 female and 12 male patients aged between 4 and 18 years. After characterization of the sequence, we tested a possible association between rs12917 and age, gender, Ann Arbor stage, treatment group, metabolic response following two courses of OEPA (vincristine, etoposide, prednisone, and doxorubicin) chemotherapy, radiotherapy indication, and relapse status. RESULTS We detected the minor T allele in four of five HL cell lines. 11/29 patients carried the minor T allele whereas 18/29 patients showed homozygosity for the major C allele. Interestingly, we observed significantly better metabolic response in PHL patients carrying the rs12917 C allele resulting in a lower frequency of radiotherapy indication. CONCLUSION MGMT polymorphism rs12917 seems to affect chemotherapy response in PHL. The prognostic value of this polymorphism should be investigated in a larger patient cohort.
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Affiliation(s)
- Stefanie Kewitz-Hempel
- Department of Pediatrics I, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle, Germany.,Department of Pediatric Hematology and Oncology, Justus Liebig University, Giessen, Germany.,Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital of Leipzig, 04103, Leipzig, Germany
| | - Michaela Cepelova
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Praha, Czech Republic
| | - Ines Volkmer
- Department of Pediatrics I, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle, Germany
| | | | - Elke Conrad
- Department of Nuclear Medicine, Helios Hospital Erfurt, Erfurt, Germany
| | - Stephanie Knirsch
- Pediatrics 5 (Oncology, Hematology, and Immunology), Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Gabriele Pöpperl
- Department of Nuclear Medicine, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Daniel Steinbach
- Department of Pediatric Hematology and Oncology, University Hospital Ulm, Ulm, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, University Hospital, Ulm, Germany
| | - Christof M Kramm
- Department of Pediatrics I, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle, Germany.,Division of Pediatric Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Bernhard Erdlenbruch
- University Hospital for Children and Adolescents, Johannes Wesling Klinikum Minden, Ruhr University Hospital, Bochum, Germany
| | - Wolf-Dieter Reinbold
- Universitätsinstitut für Diagnostische Radiologie, Neuroradiologie und Nuklearmedizin, Johannes Wesling Klinikum Minden, Ruhr University Hospital, Bochum, Germany
| | - Andreas Odparlik
- Department of Nuclear Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, 04103, Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, 04103, Leipzig, Germany.
| | - Martin S Staege
- Department of Pediatrics I, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle, Germany.
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Barrington SF, Kluge R. FDG PET for therapy monitoring in Hodgkin and non-Hodgkin lymphomas. Eur J Nucl Med Mol Imaging 2017; 44:97-110. [PMID: 28411336 PMCID: PMC5541086 DOI: 10.1007/s00259-017-3690-8] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 12/15/2022]
Abstract
PET using 18F-FDG for treatment monitoring in patients with lymphoma is one of the most well-developed clinical applications. PET/CT is nowadays used during treatment to assess chemosensitivity, with response-adapted therapy given according to 'interim' PET in clinical practice to adults and children with Hodgkin lymphoma. PET is also used to assess remission from disease and to predict prognosis in the pretransplant setting. Mature data have been reported for the common subtypes of aggressive B-cell lymphomas, with more recent data also supporting the use of PET for response assessment in T-cell lymphomas. The Deauville five-point scale incorporating the Deauville criteria (DC) is recommended for response assessment in international guidelines. FDG uptake is graded in relation to the reference regions of normal mediastinum and liver. The DC have been validated in most lymphoma subtypes. The DC permit the threshold for adequate or inadequate response to be adapted according to the clinical context or research question. It is important for PET readers to understand how the DC have been applied in response-adapted trials for correct interpretation and discussion with the multidisciplinary team. Quantitative methods to perform PET in standardized ways have also been developed which may further improve response assessment including a quantitative extension to the DC (qPET). This may have advantages in providing a continuous scale to refine the threshold for adequate/inadequate response in specific clinical situations or treatment optimization in trials. qPET is also less observer-dependent and limits the problem of optical misinterpretation due to the influence of background activity.
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Affiliation(s)
- Sally F Barrington
- PET Imaging Centre, King's College London and Guy's, King's Health Partners, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, 0410, Leipzig, Germany
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Prediction of outcome in pediatric Hodgkin lymphoma based on interpretation of 18FDG-PET/CT according to ΔSUVmax, Deauville 5-point scale and IHP criteria. Ann Nucl Med 2017; 31:660-668. [DOI: 10.1007/s12149-017-1196-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 07/09/2017] [Indexed: 10/19/2022]
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Farruggia P, Puccio G, Sala A, Todesco A, Terenziani M, Mura R, D'Amico S, Casini T, Mosa C, Pillon M, Boaro MP, Bottigliero G, Burnelli R, Consarino C, Fedeli F, Mascarin M, Perruccio K, Schiavello E, Trizzino A, Ficola U, Garaventa A, Rossello M. Abdomen/pelvis computed tomography in staging of pediatric Hodgkin Lymphoma: is it always necessary? Cancer Med 2016; 5:2359-67. [PMID: 27485192 PMCID: PMC5055149 DOI: 10.1002/cam4.829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/21/2016] [Accepted: 06/27/2016] [Indexed: 01/27/2023] Open
Abstract
The purpose of the study was to determine if abdomen/pelvis computed tomography (CT) can be safety omitted in the initial staging of a subgroup of children affected by Hodgkin Lymphoma (HL). Every participating center of A.I.E.O.P (Associazione Italiana di Ematologia ed Oncologia Pediatrica) sent local staging reports of 18F‐fluorodeoxyglucose positron emission tomography (PET) and abdominal ultrasound (US) along with digital images of staging abdomen/pelvis CT to the investigation center where the CT scans were evaluated by an experienced pediatric radiologist. The local radiologist who performed the US was unaware of local CT and PET reports (both carried out after US), and the reviewer radiologist examining the CT images was unaware of local US, PET and CT reports. A new abdominal staging of 123 patients performed on the basis of local US report, local PET report, and centralized CT report was then compared to a simpler staging based on local US and PET. No additional lesion was discovered by CT in patients with abdomen/pelvis negativity in both US and PET or isolated spleen positivity in US (or US and PET), and so it seems that in the initial staging, abdomen/pelvis CT can be safety omitted in about 1/2 to 2/3 of children diagnosed with HL.
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Affiliation(s)
- Piero Farruggia
- Pediatric Hematology and Oncology Unit, Oncology Department, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy. ,
| | - Giuseppe Puccio
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy
| | - Alessandra Sala
- Clinica Pediatrica, Universita' Milano - Bicocca, A.O. San Gerardo, Fondazione Monza e Brianza per il bambino e la sua mamma (MBBM), Monza, Italy
| | - Alessandra Todesco
- Dipartimento di Oncoematologia Pediatrica, Università di Padova, Padova, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Rosamaria Mura
- Pediatric Hematology-Oncology, Ospedale Pediatrico Microcitemico, Cagliari, Italy
| | | | - Tommaso Casini
- Dipartimento di Oncoematologia Pediatrica, A.O.U Meyer, Firenze, Italy
| | - Clara Mosa
- Pediatric Hematology and Oncology Unit, Oncology Department, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
| | - Marta Pillon
- Dipartimento di Oncoematologia Pediatrica, Università di Padova, Padova, Italy
| | - Maria Paola Boaro
- Dipartimento di Oncoematologia Pediatrica, Università di Padova, Padova, Italy
| | - Gaetano Bottigliero
- Dipartimento di Pediatria II Ateneo di Napoli, Servizio di Oncologia Pediatrica, Napoli, Italy
| | - Roberta Burnelli
- Oncoematologia Pediatrica, Azienda Ospedaliera Universitaria, Ospedale Sant'Anna, Ferrara, Italy
| | - Caterina Consarino
- Pediatric Hemato-oncology Unit, Dipartimento di Onco-Ematologia, Catanzaro Hospital, Catanzaro, Italy
| | - Fausto Fedeli
- Department of Pediatrics, Niguarda Ca' Granda Hospital, Milano, Italy
| | - Maurizio Mascarin
- S.S. Radioterapia Pediatrica e Area Giovani, IRCCS, Centro di Riferimento Oncologico Aviano, Pordenone, Italy
| | - Katia Perruccio
- Oncoematologia Pediatrica, Azienda Ospedaliera-Universitaria di Perugia, Perugia, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Angela Trizzino
- Pediatric Hematology and Oncology Unit, Oncology Department, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
| | - Umberto Ficola
- Dipartimento Oncologico La Maddalena, Medicina Nucleare, Palermo, Italy
| | - Alberto Garaventa
- Dipartimento di Ematologia e Oncologia Pediatrica Istituto G. Gaslini, Genova, Italy
| | - Mario Rossello
- Radiology Unit, Radiology Department, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
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Kluge R, Chavdarova L, Hoffmann M, Kobe C, Malkowski B, Montravers F, Kurch L, Georgi T, Dietlein M, Wallace WH, Karlen J, Fernández-Teijeiro A, Cepelova M, Wilson L, Bergstraesser E, Sabri O, Mauz-Körholz C, Körholz D, Hasenclever D. Inter-Reader Reliability of Early FDG-PET/CT Response Assessment Using the Deauville Scale after 2 Cycles of Intensive Chemotherapy (OEPA) in Hodgkin's Lymphoma. PLoS One 2016; 11:e0149072. [PMID: 26963909 PMCID: PMC4786307 DOI: 10.1371/journal.pone.0149072] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/11/2016] [Indexed: 02/07/2023] Open
Abstract
Purpose The five point Deauville (D) scale is widely used to assess interim PET metabolic response to chemotherapy in Hodgkin lymphoma (HL) patients. An International Validation Study reported good concordance among reviewers in ABVD treated advanced stage HL patients for the binary discrimination between score D1,2,3 and score D4,5. Inter-reader reliability of the whole scale is not well characterised. Methods Five international expert readers scored 100 interim PET/CT scans from paediatric HL patients. Scans were acquired in 51 European hospitals after two courses of OEPA chemotherapy (according to the EuroNet-PHL-C1 study). Images were interpreted in direct comparison with staging PET/CTs. Results The probability that two random readers concord on the five point D score of a random case is only 42% (global kappa = 0.24). Aggregating to a three point scale D1,2 vs. D3 vs. D4,5 improves concordance to 60% (kappa = 0.34). Concordance if one of two readers assigns a given score is 70% for score D1,2 only 36% for score D3 and 64% for D4,5. Concordance for the binary decisions D1,2 vs. D3,4,5 is 67% and 86% for D1,2,3 vs D4,5 (kappa = 0.36 resp. 0.56). If one reader assigns D1,2,3 concordance probability is 92%, but only 64% if D4,5 is called. Discrepancies occur mainly in mediastinum, neck and skeleton. Conclusion Inter-reader reliability of the five point D-scale is poor in this interobserver analysis of paediatric patients who underwent OEPA. Inter-reader variability is maximal in cases assigned to D2 or D3. The binary distinction D1,2,3 versus D4,5 is the most reliable criterion for clinical decision making.
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Affiliation(s)
- Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Lidia Chavdarova
- Clinic of Nuclear Medicine, National Hospital for Active Treatment in Oncology, Sofia, Bulgaria
| | - Martha Hoffmann
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Carsten Kobe
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - Bogdan Malkowski
- Dept. of PET and Molecular Imaging, Nicolaus Copernicus University, Collegium MedicumBydgoszcz, Poland
| | - Françoise Montravers
- Department of Nuclear Medicine, Hopital Tenon, Assistance Publique Hôpitaux de Paris, Faculté de médecine Pierre et Marie Curie, Paris, France
| | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Thomas Georgi
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Markus Dietlein
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - W. Hamish Wallace
- Department of Paediatric Oncology, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, United Kingdom
| | - Jonas Karlen
- Karolinska University Hospital, Astrid Lindgrens Childrens Hospital, Stockholm, Sweden
| | - Ana Fernández-Teijeiro
- Pediatric Oncology Unit, Hospitales Universitarios Virgen Macarena y Virgen del Rocio, Sevilla, Spain
| | - Michaela Cepelova
- Department of Pediatric Hematology and Oncology, University Hospital Motol and 2nd Medical Faculty of Charles University, Prague, Czech Republic
| | - Lorrain Wilson
- Department of Nuclear Medicine, Blackrock Clinic, Dublin, Ireland
| | - Eva Bergstraesser
- Department of Paediatric Oncology, University Children’s Hospital Zurich, Switzerland
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | | | - Dieter Körholz
- Department of Pediatric Oncology, University of Halle, Halle/Saale, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
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FDG-PET Response Prediction in Pediatric Hodgkin's Lymphoma: Impact of Metabolically Defined Tumor Volumes and Individualized SUV Measurements on the Positive Predictive Value. Cancers (Basel) 2015; 7:287-304. [PMID: 25635760 PMCID: PMC4381259 DOI: 10.3390/cancers7010287] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 01/21/2015] [Indexed: 12/22/2022] Open
Abstract
Background: In pediatric Hodgkin’s lymphoma (pHL) early response-to-therapy prediction is metabolically assessed by (18)F-FDG PET carrying an excellent negative predictive value (NPV) but an impaired positive predictive value (PPV). Aim of this study was to improve the PPV while keeping the optimal NPV. A comparison of different PET data analyses was performed applying individualized standardized uptake values (SUV), PET-derived metabolic tumor volume (MTV) and the product of both parameters, termed total lesion glycolysis (TLG); Methods: One-hundred-eight PET datasets (PET1, n = 54; PET2, n = 54) of 54 children were analysed by visual and semi-quantitative means. SUVmax, SUVmean, MTV and TLG were obtained the results of both PETs and the relative change from PET1 to PET2 (Δ in %) were compared for their capability of identifying responders and non-responders using receiver operating characteristics (ROC)-curves. In consideration of individual variations in noise and contrasts levels all parameters were additionally obtained after threshold correction to lean body mass and background; Results: All semi-quantitative SUV estimates obtained at PET2 were significantly superior to the visual PET2 analysis. However, ΔSUVmax revealed the best results (area under the curve, 0.92; p < 0.001; sensitivity 100%; specificity 85.4%; PPV 46.2%; NPV 100%; accuracy, 87.0%) but was not significantly superior to SUVmax-estimation at PET2 and ΔTLGmax. Likewise, the lean body mass and background individualization of the datasets did not impove the results of the ROC analyses; Conclusions: Sophisticated semi-quantitative PET measures in early response assessment of pHL patients do not perform significantly better than the previously proposed ΔSUVmax. All analytical strategies failed to improve the impaired PPV to a clinically acceptable level while preserving the excellent NPV.
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Purz S, Sabri O, Viehweger A, Barthel H, Kluge R, Sorge I, Hirsch FW. Potential Pediatric Applications of PET/MR. J Nucl Med 2014; 55:32S-39S. [PMID: 24762622 DOI: 10.2967/jnumed.113.129304] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Medical imaging with multimodality and whole-body technologies has continuously improved in recent years. The advent of combined modalities such as PET/CT and PET/MR offers new tools with an exact fusion of molecular imaging and high-resolution anatomic imaging. For noninvasive pediatric diagnostics, molecular imaging and whole-body MR have become important, especially in pediatric oncology. Because it has a lower radiation exposure than PET/CT, combined PET/MR is expected to be of special use in pediatric diagnostics. This review focuses on possible pediatric applications of PET/MR hybrid imaging, particularly pediatric oncology and neurology but also the diagnosis of infectious or inflammatory diseases.
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Affiliation(s)
- Sandra Purz
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany; and
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany; and
| | - Adrian Viehweger
- Department of Pediatric Radiology, University Hospital of Leipzig, Leipzig, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany; and
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany; and
| | - Ina Sorge
- Department of Pediatric Radiology, University Hospital of Leipzig, Leipzig, Germany
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Hasenclever D, Kurch L, Mauz-Körholz C, Elsner A, Georgi T, Wallace H, Landman-Parker J, Moryl-Bujakowska A, Cepelová M, Karlén J, Álvarez Fernández-Teijeiro A, Attarbaschi A, Fosså A, Pears J, Hraskova A, Bergsträsser E, Beishuizen A, Uyttebroeck A, Schomerus E, Sabri O, Körholz D, Kluge R. qPET - a quantitative extension of the Deauville scale to assess response in interim FDG-PET scans in lymphoma. Eur J Nucl Med Mol Imaging 2014; 41:1301-8. [PMID: 24604592 DOI: 10.1007/s00259-014-2715-9] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 01/20/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Interim FDG-PET is used for treatment tailoring in lymphoma. Deauville response criteria consist of five ordinal categories based on visual comparison of residual tumor uptake to physiological reference uptakes. However, PET-response is a continuum and visual assessments can be distorted by optical illusions. OBJECTIVES With a novel semi-automatic quantification tool we eliminate optical illusions and extend the Deauville score to a continuous scale. PATIENTS AND METHODS SUVpeak of residual tumors and average uptake of the liver is measured with standardized volumes of interest. The qPET value is the quotient of these measurements. Deauville scores and qPET-values were determined in 898 pediatric Hodgkin's lymphoma patients after two OEPA chemotherapy cycles. RESULTS Deauville categories translate to thresholds on the qPET scale: Categories 3, 4, 5 correspond to qPET values of 0.95, 1.3 and 2.0, respectively. The distribution of qPET values is unimodal with a peak representing metabolically normal responses and a tail of clearly abnormal outliers. In our patients, the peak is at qPET = 0.95 coinciding with the border between Deauville 2 and 3. qPET cut values of 1.3 or 2 (determined by fitting mixture models) select abnormal metabolic responses with high sensitivity, respectively, specificity. CONCLUSIONS qPET methodology provides semi-automatic quantification for interim FDG-PET response in lymphoma extending ordinal Deauville scoring to a continuous scale. Deauville categories correspond to certain qPET cut values. Thresholds between normal and abnormal response can be derived from the qPET-distribution without need for follow-up data. In our patients, qPET < 1.3 excludes abnormal response with high sensitivity.
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Affiliation(s)
- Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
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Abstract
The aim of this review is to give an overview of FDG PET/CT applications in children and adolescents with lymphoma. Today, FDG PET is used for tailoring treatment intensity in children with Hodgkin lymphoma within the framework of international treatment optimisation protocols. In contrast, the role of this method in children with Non-Hodgkin lymphoma is not well defined. This paper overviews clinical appearance and metabolic behaviour of the most frequent lymphoma subtypes in childhood. The main focus of the review is to summarise knowledge about the role of FDG PET/CT for initial staging and early response assessment.
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Hirsch FW, Sattler B, Sorge I, Kurch L, Viehweger A, Ritter L, Werner P, Jochimsen T, Barthel H, Bierbach U, Till H, Sabri O, Kluge R. PET/MR in children. Initial clinical experience in paediatric oncology using an integrated PET/MR scanner. Pediatr Radiol 2013; 43:860-75. [PMID: 23306377 PMCID: PMC3691480 DOI: 10.1007/s00247-012-2570-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 10/04/2012] [Accepted: 10/06/2012] [Indexed: 01/04/2023]
Abstract
Use of PET/MR in children has not previously been reported, to the best of our knowledge. Children with systemic malignancies may benefit from the reduced radiation exposure offered by PET/MR. We report our initial experience with PET/MR hybrid imaging and our current established sequence protocol after 21 PET/MR studies in 15 children with multifocal malignant diseases. The effective dose of a PET/MR scan was only about 20% that of the equivalent PET/CT examination. Simultaneous acquisition of PET and MR data combines the advantages of the two previously separate modalities. Furthermore, the technique also enables whole-body diffusion-weighted imaging (DWI) and statements to be made about the biological cellularity and nuclear/cytoplasmic ratio of tumours. Combined PET/MR saves time and resources. One disadvantage of PET/MR is that in order to have an effect, a significantly longer examination time is needed than with PET/CT. In our initial experience, PET/MR has turned out to be an unexpectedly stable and reliable hybrid imaging modality, which generates a complementary diagnostic study of great additional value.
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Affiliation(s)
- Franz Wolfgang Hirsch
- Department of Paediatric Radiology, University of Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany.
| | - Bernhard Sattler
- Department of Nuclear Medicine, University of Leipzig, Liebigstr. 18, 04103 Leipzig, Germany
| | - Ina Sorge
- Department of Paediatric Radiology, University of Leipzig, Liebigstr. 20a, 04103 Leipzig, Germany
| | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Liebigstr. 18, 04103 Leipzig, Germany
| | - Adrian Viehweger
- Department of Paediatric Radiology, University of Leipzig, Liebigstr. 20a, 04103 Leipzig, Germany
| | - Lutz Ritter
- Department of Paediatric Radiology, University of Leipzig, Liebigstr. 20a, 04103 Leipzig, Germany
| | - Peter Werner
- Department of Nuclear Medicine, University of Leipzig, Liebigstr. 18, 04103 Leipzig, Germany
| | - Thies Jochimsen
- Department of Nuclear Medicine, University of Leipzig, Liebigstr. 18, 04103 Leipzig, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig, Liebigstr. 18, 04103 Leipzig, Germany
| | - Uta Bierbach
- Department of Paediatric Oncology, University of Leipzig, Liebigstr. 20a, 04103 Leipzig, Germany
| | - Holger Till
- Department of Paediatric Surgery, University of Leipzig, Liebigstr. 20a, 04103 Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Liebigstr. 18, 04103 Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Liebigstr. 18, 04103 Leipzig, Germany
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PET/MRI in cancer patients: first experiences and vision from Copenhagen. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2012; 26:37-47. [DOI: 10.1007/s10334-012-0357-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 11/28/2012] [Accepted: 11/29/2012] [Indexed: 01/08/2023]
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Knäusl B, Lütgendorf-Caucig C, Hopfgartner J, Dieckmann K, Kurch L, Pelz T, Pötter R, Georg D. Can treatment of pediatric Hodgkin’s lymphoma be improved by PET imaging and proton therapy? Strahlenther Onkol 2012; 189:54-61. [DOI: 10.1007/s00066-012-0235-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/17/2012] [Indexed: 01/16/2023]
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Lackner H, Strenger V, Sovinz P, Beham-Schmid C, Pilhatsch A, Benesch M, Schwinger W, Ulreich R, Schmidt S, Urban C. Bone marrow necrosis in a girl with Hodgkin's disease. Support Care Cancer 2012; 20:2231-4. [PMID: 22773298 DOI: 10.1007/s00520-012-1502-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 05/14/2012] [Indexed: 10/28/2022]
Abstract
Bone marrow necrosis (BMN) is a rare finding in children with malignancy occurring most commonly in children with acute lymphoblastic leukemia. This article describes the first case of a girl who developed BMN during treatment for Hodgkin's disease. During the second cycle of chemotherapy, she experienced sudden profound bone pain in the lumbosacral region associated with elevated levels of lactate dehydrogenase (LDH), fibrin degradation products (D-Dimer), and alkaline phosphatase as well as pancytopenia and leukoerythroblastosis. MRI studies showed multiple confluent areas with low signal intensity and rim contrast enhancement in all vertebral bodies. Bone marrow biopsy revealed focal necrosis within hypocellular bone marrow. The patient responded quickly to symptomatic treatment with analgetics and heparin; however, elevations of LDH and D-Dimer persisted for 1.5 and 8 months, respectively. Clinicians should be aware of this rare condition to establish the diagnosis and to continue oncologic treatment as early as possible.
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Affiliation(s)
- Herwig Lackner
- Division of Pediatric Hematology/Oncology, Medical University of Graz, Graz, Austria
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