Dual Faz PET/BT’nin Lenfoma Tanisi Almiş Hastalarda Tedaviye Yaniti Öngörmedeki Rolü

Abstract

Amaç: Çalışmanın amacı, malign lenfoma (ML) hastalarında F-18 florodeoksiglukoz (FDG) PET/BT dual faz incelemesinin semikantitatif parametrelerle tedavi yanıtını öngörmedeki klinik değerini araştırmaktır. Materyal ve Metot: ML (Hodgkin Lenfoma (HL), İndolent ve agresif non-Hodgkin Lenfoma (NHL)) tanısı almış 39 hastada toplam 847 lezyonu değerlendirildi. Her bir lezyon için erken ve geç görüntülemelerde metabolik tümör hacmi (MTV), maksimum standart tutulum değeri (SUVmax) ve total glikolitik aktivite (TGA) hesaplandı; ayrıca tutulum indeksleri (RI) elde edildi. Ardından ara dönem PET/BT (interim PET/BT) görüntüleme yapıldı. Tedavi yanıtını (tam yanıt [CR] ve kısmi yanıt [PR]) değerlendirmede SUVmax ve TGA kesim değerlerinin performansı ROC eğrisi analizi ve çok değişkenli lojistik regresyon ile analiz edildi. Bulgular: Çalışmada yer alan 847 lezyondan, 31 hastada 817’si tam yanıt (TY) ve 8 hastada 30’u kısmi yanıt (KY) olarak saptandı. Bulgular, ΔSUVmax, ΔTGA ve TGA tutulum indeksinin (RI-TGA) KY lezyonlarında TY lezyonlarına göre anlamlı derecede yüksek olduğunu ancak RI-SUVmax açısından fark bulunmadığını gösterdi. Kesim değerleri sırasıyla ΔSUVmax > 3,7, ΔTGA > 14,94 ve RI-TGA > %26,85 olarak belirlendi; bu değerlerin KY olasılığını 3.5 kat artırdığı görüldü. Hasta bazlı değerlendirmede, tüm vücut TGA değişimi (ΔWB-TGA) için 181.98 kesim değeri anlamlı bulundu (duyarlılık %100, özgüllük %67,74, pozitif prediktif değer %44,4, negatif prediktif değer %100). Sonuç: ΔSUVmax, ΔTGA ve RI-TGA değerleri, lezyon bazında tedavi yanıtını öngörmede kullanılabilirken; hasta bazlı değerlendirmede sadece ΔWB -TGA anlamlı öngörücü faktör bulunmuştur. Dual faz görüntüleme ve TGA değerlendirmesi, tedavi yanıtını öngörmede ve kişiselleştirilmiş tedavi planlarının oluşturulmasında değerli olabilir.

Keywords

• Dual Faz görüntüleme
• Malign Lenfoma
• Pozitron Emisyon Tomografi bilgisayarlı Tomografi

Project Number

Project no: KOU KAEK2012/146

Ethical Statement

Çalışma protokolü Kocaeli Üniversitesi Tıp Fakültesi Etik Kurulu tarafından onaylanmış ve Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüştür (karar no. 04.12.2012 – 16/7). Bilgilendirilmiş onam alınmıştır.

Role of Dual-Time-Point F18-FDG PET/CT for Predicting the Response of Therapy In Patients With Malignant Lymphoma

Abstract

Objective: This study aims to evaluate the clinical value of F-18 fluorodeoxyglucose (FDG) dual-time-point (DTP) PET/CT with semiquantitative analyses for predicting therapy response in patients with malignant lymphoma (ML). Materials and Methods: We evaluated 847 lesions in 39 patients diagnosed with ML, including Hodgkin Lymphoma (HL) and aggressive and indolent non-Hodgkin lymphoma (NHL). We calculated metabolic tumor volume (MTV), standardized uptake value (SUVmax), and total glycolytic activity (TGA) for each lesion during early (60 min) and delayed (120 min) scans, along with retention indices (RI). Interim PET/CT was then performed, and the performance of SUVmax and TGA cutoff values for assessing treatment response (Complete Response (CR) and Partial Response (PR)) was analyzed using ROC curve analysis and multivariate logistic regression. Results: In a study of 847 lesions, 817 CR lesions from 31 patients and 30 PR lesions from 8 patients were examined. The results showed that ΔSUVmax, ΔTGA, and the retention index in TGA (RI-TGA) were significantly higher in PR lesions compared to CR lesions, whereas no difference was observed for RI-SUVmax. The cut-off values established were ΔSUVmax > 3.7, ΔTGA > 14.94, and RI-TGA > 26.85%, indicating a 3.5 times greater likelihood of PR. For patient-based assessments, change in whole-body TGA (ΔWB-TGA) with a cut-off of 181.98 was significant (sensitivity 100%, specificity 67.74%, PPV 44.4%, NPV 100%) Conclusions: ΔSUVmax, ΔTGA, and RI-TGA values may predict therapy response based on lesion evaluation, while only ΔWBTGA is a significant factor based on patient evaluation. Dual-time imaging and TGA assessment may help predict therapy responses and guide personalized treatment plans.

Keywords

• Dual-time-point imaging
• Malignant Lymphoma
• Positron Emission Tomography/ Computed Tomography

Project Number

Project no: KOU KAEK2012/146

Ethical Statement

The study protocol was approved by the Kocaeli University Faculty of Medicine Ethics Committee and was conducted in accordance with the principles of the Declaration of Helsinki (decision no. 04.12.2012 – 16/7). Informed consent was obtained.

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