End Of Chemotherapy Response In Lymphoma Patients: The Predictive Value Of Dual Time Point Imaging Of Minimal Residual Uptake Lesions During Interim Pet-Ct
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Date
2017
Authors
Yusop, Mohd Syahrir
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
Introduction Early treatment response assessment in lymphoma is important as it
allows physicians to identify patients with poor response to treat earlier. Interim
Fluorine-18 Fluorodeoxyglucose (FDG) Positron Emission Tomography – Computed
Tomography (PET-CT) scan is currently regarded as an investigational imaging tool in
evaluating early treatment response in lymphoma as clinical trials evaluating it’s use are
still on-going. The presence of minimal residual uptake (MRU) lesion in interim PETCT
scan possess uncertainty in interpreting early treatment response whether MRU
lesion should be considered as representing poor treatment response. To characterize
MRU lesions in interim FDG PET-CT scan, dual time point imaging (DTPI) technique
with semi-quantitative analysis is used. This study is aimed to determine the predictive
value of DTPI technique in predicting the end chemotherapy response of lymphoma
patients with MRU lesions identified on interim FDG PET-CT scan.
Methodology Prospective study was performed at the Department of Molecular
Imaging and Nuclear Medicine, Hospital Canselor Tuanku Muhriz from April 2014 to
August 2015 recruiting 28 lymphoma patients with 67 MRU lesions. DTPI technique
was applied to interim FDG PET-CT scan to characterize MRU lesions by measuring
their early and delayed maximum standardized uptake values (SUVmax) and calculating
the SUVmax change, changes in metabolic tumour volume (MTV) as well as the
retention index (RI). Upon completion of chemotherapy, patients underwent end
treatment FDG PET-CT scan. Patients were divided into responder and non-responder
group based on Lugano’s Classification for end treatment response assessment.
Results Interim PET-CT predicted the end-treatment PET-CT findings with accuracy of
95%. SUVmax of responders was significantly lower than that of non-responder.
However, there was no statistical significant difference between the median SUVmax
change (p= 0.422) and median MTV change (p= 0.930) of MRU lesions in responder
and non-responder groups. There is also no statistical significant difference between RI
in responder and non-responder groups (p = 0.862). MRU lesions with Deauville 3 at
interim PET-CT were less predictable end-treatment response.
Conclusion DTPI technique applied during interim PET-CT has no predictive role in
indicating end chemotherapy response in lymphoma patients with MRU lesions.
Description
Keywords
Chemotherapy response of lymphoma patients , with MRU lesions identified on interim FDG PET-CT scan