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DOI: 10.1055/a-1735-3477
Dual-Layer Spectral Detector CT in Comparison with FDG-PET/CT for the Assessment of Lymphoma Activity
Dual-Layer Spektraldetektor-CT im Vergleich mit FDG-PET/CT zur Beurteilung von LymphomaktivitätAbstract
Purpose In patients with malignant lymphoma, disease activity is recommended to be assessed by FDG-PET/CT and the Deauville five-point scale (5-PS). The purpose of this study was to explore the potential of iodine concentration measured in contrast-enhanced dual-layer spectral detector CT (SDCT) as an alternative surrogate parameter for lymphoma disease activity by investigating its correlation with maximum standardized uptake values (SUVmax) and 5-PS.
Materials and Methods 25 patients were retrospectively analyzed. Contrast-enhanced SDCT and FDG-PET/CT were performed in the same treatment interval within at most 3 months. CT attenuation values (AV), absolute iodine concentrations (aIC), and normalized iodine concentrations (nIC) of lymphoma lesions were correlated with SUVmax using Spearman’s rank correlation coefficient. The performance of aIC and nIC to detect lymphoma activity (defined as 5-PS > 3) was determined using ROC curves.
Results 60 lesions were analyzed, and 31 lesions were considered active. AV, aIC, and nIC all correlated significantly with SUVmax. The strongest correlation (Spearman ρ = 0.71; p < 0.001) and highest area under the ROC curve (AUROC) for detecting lymphoma activity were observed for nIC normalized to inferior vena cava enhancement (AUROC = 0.866). The latter provided sensitivity, specificity, and diagnostic accuracy of 87 %, 75 %, and 80 %, respectively, at a threshold of 0.20. ROC analysis for AV (AUROC = 0.834) and aIC (AUROC = 0.853) yielded similar results.
Conclusion In malignant lymphomas, there is a significant correlation between metabolic activity as assessed by FDG-PET/CT and iodine concentration as assessed by SDCT. Iodine concentration shows promising diagnostic performance for detecting lymphoma activity and may represent a potential imaging biomarker.
Key Points:
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Iodine concentration correlates significantly with SUVmax in lymphoma patients
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Iodine concentration may represent a potential imaging biomarker for detecting lymphoma activity
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Normalization of iodine concentration improves diagnostic performance of iodine concentration
Citation Format
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Gehling K, Mokry T, Do TD et al. Dual-Layer Spectral Detector CT in Comparison with FDG-PET/CT for the Assessment of Lymphoma Activity. Fortschr Röntgenstr 2022; 194: 747 – 754
Zusammenfassung
Ziel Zur Bestimmung der Krankheitsaktivität maligner Lymphome werden das FDG-PET/CT und die Deauville 5-Punkte-Skala (5-PS) empfohlen. Als potenzieller CT-basierter Biomarker für Krankheitsaktivität kann die Jodkonzentration in Lymphomläsionen mit der Dual-Layer Spektraldetektor-CT (SDCT) quantifiziert werden. Ziel dieser Studie war, die Jodkonzentration mit den SUV-Werten (SUVmax) zu korrelieren und die diagnostische Wertigkeit der Jodkonzentration mit der 5-PS als Referenzstandard zu bestimmen.
Material und Methoden 25 Lymphompatienten wurden retrospektiv analysiert. SDCTs in der portalvenösen Phase und FDG-PET/CTs wurden innerhalb von maximal 3 Monaten ohne zwischenzeitlichen Therapiewechsel durchgeführt. Der Zusammenhang zwischen CT-Dichtewerten, absoluten Jodkonzentrationen (aIC) sowie normalisierten Jodkonzentrationen (nIC) und SUVmax wurden mittels Spearman-Rangkorrelationskoeffizienten untersucht. Die Vorhersagekraft von aIC und nIC zur Beurteilung der Lymphomaktivität (5-PS> 3) wurde durch Receiver Operating Characteristics (ROC)-Kurven geprüft.
Ergebnisse Insgesamt wurden 60 Läsionen analysiert und 31 Läsionen gemäß 5-PS als aktiv gewertet. CT-Dichtewerte, aIC and nIC korrelierten signifikant mit SUVmax. Die stärkste Korrelation (Spearman ρ = 0.71; p < 0.001) und der höchste Wert für die Fläche unter der ROC-Kurve (AUROC) zur Detektion von Lymphomaktivität wurde für nIC normalisiert auf die Vena cava inferior beobachtet (AUROC = 0.866). Hierfür ergaben sich eine Sensitivität von 87 %, eine Spezifität von 75 % sowie eine Genauigkeit von 80 % bei einem Schwellenwert von 0.20. ROC-Analysen für die Dichtewerte (AUROC = 0.834) und aIC (AUROC = 0.853) zeigten vergleichbare Ergebnisse.
Schlussfolgerung Die mittels SDCT ermittelte Jodkonzentration korreliert signifikant mit der mittels FDG-PET/CT ermittelten metabolischen Aktivität maligner Lymphome. Die Jodkonzentration zeigt vielversprechende diagnostische Vorhersagekraft zur Detektion von Lymphomaktivität.
Kernaussagen:
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Die Jodkonzentration maligner Lymphome korreliert signifikant mit SUV-Werten
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Die Jodkonzentration stellt einen potenziellen Biomarker für die Detektion von Lymphomaktivität dar
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Die Normalisierung der Jodkonzentration verbessert die diagnostische Vorhersagekraft
Publication History
Received: 12 September 2021
Accepted: 23 December 2021
Article published online:
24 February 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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