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

Yıl 2025, Cilt: 10 Sayı: 4, 411 - 418, 20.12.2025

Esra Çiftçi , Serkan İşgören , Gözde Dağlıöz Görür , Hakan Demir

https://doi.org/10.26453/otjhs.1802040

Öz

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.

Anahtar Kelimeler

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

Etik Beyan

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.

Destekleyen Kurum

-

Proje Numarası

Project no: KOU KAEK2012/146

Teşekkür

-

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

Öz

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.

Anahtar Kelimeler

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

Etik Beyan

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.

Destekleyen Kurum

-

Proje Numarası

Project no: KOU KAEK2012/146

Teşekkür

-

Kaynakça

• Al Tabaa Y, Bailly C, Kanoun S. FDG-PET/CT in Lymphoma: Where Do We Go Now? Cancers (Basel). 2021; 13(20):5222. doi:10.3390/cancers13205222
• Wang Y, Shi Q, Shi ZY, et al. Biological signatures of the International Prognostic Index in diffuse large B-cell lymphoma. Blood Adv. 2024;8(7):1587–1599.
• Zeman MN, Green C, Akin EA. Spectrum of [(18)F-FDG-PET/CT Findings in Benign Lymph Node Pathology. Mol Imaging Biol. 2021;23(4):469–480.
• Houshmand S, Salavati A, Segtnan EA, Grupe P, Hoilund-Carlsen PF, Alavi A. Dual-time-point Imaging and Delayed-time-point Fluorodeoxyglucose-PET/Computed Tomography Imaging in Various Clinical Settings. PET Clin. 2016;11(1):65–84.
• Soffers F, Helsen N, Van den Wyngaert T, et al. Dual time point imaging in locally advanced head and neck cancer to assess residual nodal disease after chemoradiotherapy. EJNMMI Res. 2022;12(1):34. doi:10.1186/s13550-022-00905-y
• Samimi R, Shiri I, Ahmadyar Y, et al. Radiomics predictive modeling from dual-time-point FDG PET K(i) parametric maps: application to chemotherapy response in lymphoma. EJNMMI Res. 2023;13(1):70.  doi:10.1186/s13550-023-01022-0
• Liao C, Deng Q, Zeng L, et al. Baseline and interim (18)F-FDG PET/CT metabolic parameters predict the efficacy and survival in patients with diffuse large B-cell lymphoma. Front Oncol. 2024;14:1395824.  doi:10.3389/fonc.2024.1395824
• Li JP, Wang P, Liu FF, et al. Assessment of the efficacy and prognostic value of 18F-FDG PET-CT using deauville 5-point scale and deltaSUVmax methods in diffuse large B-cell lymphoma patients. Medicine (Baltimore). 2025 Sep 5;104(36):e44067. doi:10.1097/MD.0000000000044067
• Miceli A, Jonghi-Lavarini, L, Santo G, et al. [18F]FDG PET/CT criteria for treatment response assessment: EORTC and beyond. Clinical and Translational Imaging 2023;11:421–437. doi:10.1007/s40336-023-00578-0
• Borra A, Morbelli S, Zwarthoed C, et al. Dual-point FDG-PET/CT for treatment response assessment in Hodgkin lymphoma, when an FDG-avid lesion persists after treatment. Am J Nucl Med Mol Imaging. 2019;9(3):176–184.
• Mehesen M. PET/CT dual time point scanning in evaluation of malignant lymphoma. The Egyptian Journal Nuclear Medicine. 2015;12(12):10–27.
• Wang Y, Yang Y, Li J, Cheng D, Xu H, Huang J. Dynamic FDG PET/CT imaging: quantitative assessment, advantages and application in the diagnosis of malignant solid tumors. Front Oncol. 2025;15:1539911. doi:10.3389/fonc.2025.1539911
• Kim CY, Hong CM, Kim DH, et al. Prognostic value of whole-body metabolic tumour volume and total lesion glycolysis measured on (1)(8)F-FDG PET/CT in patients with extranodal NK/T-cell lymphoma. Eur J Nucl Med Mol Imaging. 2013;40(9):1321–1329.
• Juweid ME, Stroobants S, Hoekstra OS, et al. Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol. 2007;25(5):571–578.
• Jelicic J, Juul-Jensen K, Bukumiric Z, et al. Prognostic indices in diffuse large B-cell lymphoma: a population-based comparison and validation study of multiple models. Blood Cancer J. 2023;13(1):157. doi:10.1038/s41408-023-00930-7
• Shi X, Liu X, Li X, et al. Risk Stratification for diffuse large B-cell lymphoma by ıntegrating ınterim evaluation and ınternational prognostic ındex: A Multicenter Retrospective Study. Front Oncol. 2021;11:754964.  doi:10.3389/fonc.2021.754964
• Pinczes LI, Tothfalusi D, Dobo B, et al. DeltaSUVmax adds prognostic value to early response assessment during the first-line treatment of classical hodgkin lymphoma: a retrospective cohort study. Cancer Imaging. 2025;25(1):80.  doi:10.1186/s40644-025-00904-x
• Rekowski J, Huttmann A, Schmitz C, et al. Interim PET evaluation in diffuse large B-cell lymphoma using published recommendations: Comparison of the deauville 5-point scale and the deltaSUV(max) method. J Nucl Med. 2021;62(1):37–42.
• Russler-Germain DA, Calhoun BR, Wu N, Watkins MP, et al. FDG-PET/CT response assessment with qualitative Lugano criteria outperforms change in SUV(max) as a predictive biomarker in frontline treatment of mantle cell lymphoma. Leuk Lymphoma. 2023;64(11):1870–1874.
• d'Abadie P, Gheysens O, Lhommel R, et al. Diagnostic Superiority of Dual-Time Point [(18)F-FDG PET/CT to differentiate malignant from benign soft tissue tumors. Diagnostics (Basel). 2023;13(20):3202.  doi:10.3390/diagnostics13203202
• Lim DH, Lee JH. Relationship Between Dual Time Point FDG PET/CT and clinical prognostic ındexes in patients with high grade lymphoma: a pilot study. Nucl Med Mol Imaging. 2017;51(4):323–330.
• Christlieb SB, Strandholdt CN, Olsen BB, et al. Dual time-point FDG PET/CT and FDG uptake and related enzymes in lymphadenopathies: preliminary results. Eur J Nucl Med Mol Imaging. 2016;43(10):1824–1836.