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FDG PET/CT Response Assessment Criteria for Patients with Hodgkin’s and Non-Hodgkin’s Lymphoma at End of Therapy: A Multiparametric Approach

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Abstract

Purpose

Based on the International Harmonization Project (IHP) criteria, positron emission tomography (PET) response assessment of residual nodal masses in patients with lymphoma after completion of therapy is performed visually using mediastinal blood pool as the reference. The primary objective of this study was to define the optimal reference for PET response assessment. Secondary aim was to assess if morphological criteria on computed tomography (CT) may improve performance of PET.

Methods

This institutional review board approved retrospective study included 137 patients, with Hodgkin’s (n = 43) or non-Hodgkin’s lymphoma (n = 94) assessed for residual masses (n = 180) after completion of therapy with pathology and clinical and imaging surveillance data (mean, 19 months) as the standard of reference. Two readers independently assessed response by IHP and Deauville criteria. The addition of morphological parameters on CT was assessed in relation to therapy response.

Results

Based on the standard of reference, 36 patients (26.3 %) had residual lymphoma. For IHP and Deauville criteria, sensitivity, specificity and accuracy were 97.2 %, 97.2 % (p = 1); 79.2 %, 92.1 % (p < 0.001); and 83.9 %, 93.4 % (p = 0.001), respectively. Of the morphological parameters assessed, only change in size over course of therapy was significant (p < 0.003) and improved specificity for IHP-based interpretation to 90.4 % (p = 0.008).

Conclusions

Using liver as the visual reference to determine PET positivity for lymphoma patients being assessed for residual masses at the end of therapy improves specificity, yet maintains the high sensitivity of PET in identifying residual disease. The addition of change in size after therapy improves specificity of PET when using IHP-based but not Deauville-based interpretation.

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Acknowledgments

This manuscript has not been published before, is not under consideration for publication anywhere else and has been approved by all co-authors.

Conflict of Interest

All authors (Ur Metser, Ravi Mohan, Vaughan Beckley, Hadas Moshonov, David Hodgson, and Grainne Murphy) declare that they have no conflict of interest.

Ethical Statement

This retrospective study was approved by the institution’s Research Ethics Board (approval no. 13-6496-CE) and written informed consent from patients was waived. The study was performed in accordance with the ethical standards of the institution. The institutional research ethics board operates in compliance with the Tri-Council Policy Statement and the ICH guidelines for the Good Clinical Practice E6(R1).

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Authors and Affiliations

  1. Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, ON, Canada

    Ur Metser, Ravi Mohan, Vaughan Beckley & Grainne Murphy

  2. Office of Research and Development, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, ON, Canada

    Hadas Moshonov

  3. Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada

    David Hodgson

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  1. Ur Metser
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Correspondence to Ur Metser.

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Metser, U., Mohan, R., Beckley, V. et al. FDG PET/CT Response Assessment Criteria for Patients with Hodgkin’s and Non-Hodgkin’s Lymphoma at End of Therapy: A Multiparametric Approach. Nucl Med Mol Imaging 50, 46–53 (2016). https://doi.org/10.1007/s13139-015-0368-7

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