Nucl Med Mol Imaging.  2016 Dec;50(4):300-307. 10.1007/s13139-016-0432-y.

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

• Kim SJ
• Yi HK
• Lim CH
• Cho YS
• Choi JY
• Choe YS
• Lee KH
• Kim BT
• Moon SH

• KMID: 2386153
• DOI: http://doi.org/10.1007/s13139-016-0432-y

Abstract

PURPOSE
¹â¸F-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 SUVand 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) ofMBP 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 SUVof the MBP and liver.

Keyword

Diffuse large B-cell lymphoma; FDG; PET; Mediastinum; Liver; Myocardium

MeSH Terms

B-Lymphocytes*
Cyclophosphamide
Diagnosis
Doxorubicin
Drug Therapy*
Follow-Up Studies
Humans
Liver*
Lymphoma
Lymphoma, B-Cell*
Mediastinum
Methods
Myocardium*
Positron-Emission Tomography and Computed Tomography
Prednisolone
Rituximab
Tumor Burden
Vincristine
Cyclophosphamide
Doxorubicin
Prednisolone
Rituximab
Vincristine