The Prognostic Value of Therapeutic Evaluation Criteria in F18 FDG PET CT In Patients with Lymphoma: Comparison Between Lesion to Liver Ratio and Visual Deauville Score
Keywords:
Lymphoma- 18F-FDG PET/CT -Tumor/Liver Ratio -Deauville ScoreAbstract
Background: Malignant lymphoma is regarded as the most prevalent hematological malignancy in adults and is ranked as the fourth most frequent adult malignancy, accounting for around 8.4% of all adult malignancies diagnosed yearly.
Objective: To evaluate the prognostic value of TLR in 18F-FDG PET/CT in lymphoma patients and assess its role in the treatment response assessment and follow-up.
Methods: This cohort analytical study involved 80 patients with 139 PET/CT study diagnosed with lymphoma (including Hodgkin and non-Hodgkin lymphoma), all referred to the Center of Clinical Oncology and Nuclear Medicine (NEMROCK) between April 2022 and May 2024.
Results: TLR demonstrated excellent performance in distinguishing CMR from other outcomes, with high AUC values at interim (0.980), EOT (0.967), and follow-up (1.000) time points. Optimal TLR cut-off values were 1.111 for interim and 0.959 for EOT and follow-up assessments. TLR showed high sensitivity (75-87.50%), specificity (90.48-100%), and accuracy (85-91.94%) in predicting CMR. Significant variances in PFS have been found between patients achieving CMR and those who did not, particularly at interim (PFS: 100% vs 18.3%) and EOT (PFS: 92.4% vs 42.8%) assessments. Strong correlations were found between TLR and DS at all-time points (correlation coefficient > 0.9, p-value under 0.001).
Conclusion: TLR is a valuable specific semi-quantitative measure for assessing treatment response and predicting outcomes in lymphoma patients.
Downloads
Metrics
References
Shams TM. High expression of LMO2 in Hodgkin, Burkitt and germinal center diffuse large B cell lymphomas. Journal of the Egyptian National Cancer Institute. 2011 Dec 1;23(4):147-53.
Juweid ME. FDG-PET/CT in Lymphoma. Positron Emission Tomography. 2011:1-9.
Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Aoun P, Bello CM, Benitez CM, Bernat K, Bierman PJ, Blum KA, Chen R. Hodgkin lymphoma version 1.2017, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network. 2017 May 1;15(5):608-38.
Zelenetz AD, Gordon LI, Abramson JS, Advani RH, Bartlett NL, Caimi PF, Chang JE, Chavez JC, Christian B, Fayad LE, Glenn MJ. NCCN guidelines insights: B-cell lymphomas, version 3.2019: featured updates to the NCCN guidelines. Journal of the National Comprehensive Cancer Network. 2019 Jun 1;17(6):650-61.
Yu N, Zhang W, Zhong X, Song X, Li W. Incidence and survival of second primary non-Hodgkin lymphoma: A Surveillance, Epidemiology, and End Results-based cohort study. Plos one. 2024 Mar 11;19(3):e0300330.
Li YH, Zhao YM, Jiang YL, Tang S, Chen MT, Xiao ZZ, Fan W, Hu YY, Zhang X. The prognostic value of end-of-treatment FDG-PET/CT in diffuse large B cell lymphoma: Comparison of visual Deauville criteria and a lesion-to-liver SUV max ratio-based evaluation system. European Journal of Nuclear Medicine and Molecular Imaging. 2022 Mar 1:1-1.
ARGINASE C, BIO IS, LYMPHOMA MH. CASE REPORT OF ACUTE MYELOID LEUKEMIA SECONDARY TO PRIMARY MYELOFIBROSIS TREATED WITH AZACITIDINE. h aematologica h aemat. 2015;100(s3):84.
Wu C, Cui Y, Zhao Y, Chen X, Liao X, Di L, Yin L, Liu M, Wang R. Elevated tumor-to-liver standardized uptake value ratio (TLR) from preoperative 18F-FDG PET/CT predicts poor prognosis of patients with clear cell renal cell carcinoma after nephrectomy. European Journal of Radiology. 2020 Oct 1; 131:109218.
Johnson SA, Kumar A, Matasar MJ, Schöder H, Rademaker J. Imaging for staging and response assessment in lymphoma. Radiology. 2015 Aug;276(2):323-38.
Toledano MN, Vera P, Tilly H, Jardin F, Becker S. Comparison of therapeutic evaluation criteria in FDG-PET/CT in patients with diffuse large-cell B-cell lymphoma: prognostic impact of tumor/liver ratio. PLoS One. 2019 Feb 7;14(2): e0211649.
Annunziata S, Cuccaro A, Tisi MC, Hohaus S, Rufini V. FDG-PET/CT at the end of immuno-chemotherapy in follicular lymphoma: the prognostic role of the ratio between target lesion and liver SUVmax (rPET). Ann Nucl Med. 2018 Jun 1;32(5):372–7.
Zhang Y, Fan Y, Ying Z, Song Y, Zhu J, Yang Z, et al. Can the SUVmax-liver-based interpretation improve prognostic accuracy of interim and posttreatment 18F-FDG PET/CT in patients with diffuse large B-cell lymphoma? Leuk Lymphoma. 2018 Mar 4;59(3):660–9.
Ferrari C, Pisani AR, Masi T, Santo G, Mammucci P, Rubini D, et al. Lesion-to-Liver SUVmax Ratio to Improve the Prognostic Value of the End of Treatment PET/CT in Diffuse Large B-Cell Lymphoma. J Clin Med. 2022 Oct 1;11(19).
Annunziata S, Cuccaro A, Calcagni ML, Hohaus S, Giordano A, Rufini V. Interim FDG-PET/CT in Hodgkin lymphoma: the prognostic role of the ratio between target lesion and liver SUVmax (rPET). Ann Nucl Med. 2016 Oct 1;30(8):588–92.
Itti E, Juweid ME, Haioun C, Yeddes I, Hamza-Maaloul F, El Bez I. Improvement of Early 18F-FDG PET Interpretation in Diffuse Large B-Cell Lymphoma: Importance of the Reference Background. Journal of Nuclear Medicine [Internet]. 2010 Dec 1 [cited 2024 Sep 9];51(12):1857–62. Available from: https://jnm.snmjournals.org/content/51/12/1857
Downloads
Published
How to Cite
Issue
Section
License

This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.