qPET - a quantitative extension of the Deauville scale to assess response in interim FDG-PET scans in lymphoma

Dirk Hasenclever, Lars Kurch, Christine Mauz-Körholz, Andreas Elsner, Thomas Georgi, Hamish Wallace, Judith Landman-Parker, Angelina Moryl-Bujakowska, Michaela Cepelová, Jonas Karlén, Ana Álvarez Fernández-Teijeiro, Andishe Attarbaschi, Alexander Fosså, Jane Pears, Andrea Hraskova, Eva Bergsträsser, Auke Beishuizen, Anne Uyttebroeck, Eckhard Schomerus, Osama SabriDieter Körholz, Regine Kluge

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)1301-8
Number of pages8
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume41
Issue number7
DOIs
Publication statusPublished - Jul 2014

Keywords

  • Adolescent
  • Biological Transport
  • Child
  • Fluorodeoxyglucose F18
  • Hodgkin Disease
  • Humans
  • Image Processing, Computer-Assisted
  • Positron-Emission Tomography

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