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. 2023 Sep 1;9(9):e19749.
doi: 10.1016/j.heliyon.2023.e19749. eCollection 2023 Sep.

Prognostic value of whole-body dynamic 18F-FDG PET/CT Patlak in diffuse large B-cell lymphoma

Jiankang Yin  1 , Hui Wang  2 , Gan Zhu  2 , Ni Chen  1 , Muhammad Imran Khan  3   4   5 , Ye Zhao  1
Affiliations

Prognostic value of whole-body dynamic 18F-FDG PET/CT Patlak in diffuse large B-cell lymphoma

Jiankang Yin et al. Heliyon. .

Abstract

Objective: This study aims to investigate the significance of interim whole-body dynamic 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) Patlak parameters for predicting the prognosis of patients with diffuse large B-cell lymphoma. To estimate the predictive value of the whole-body dynamic 18F-FDG PET/CT Patlak parameter for 2-year progression-free survival (PFS) and 2-year overall survival (OS).

Methods: This study reports the findings of 67 patients with diffuse large B-cell lymphoma (DLBCL). These patients underwent interim whole-body dynamic 18F-FDG PET/CT scans from June 2021 to January 2023 at the Department of Nuclear Medicine, First Affiliated Hospital of Anhui Medical University. The predictive values of maximum standard uptake value (SUVmax), maximum of net glucose uptake rate (Kimax) and the predictive model combining Kimax and interim treatment response on the prognosis of patients was analyzed using receiver operating characteristic (ROC) curves. Kaplan-Meier survival curves and log-rank tests were used for survival analysis. Univariate and multivariate analyses were performed to screen for independent prognostic risk factors.

Results: After a median follow-up of 18 months, 21 patients (31.3%) experienced disease recurrence or death. The cut-off values for the SUVmax and the Kimax were 6.1 and 0.13 μmol min-1·ml-1, respectively. Ann Arbor stage, IPI, SUVmax, Kimax and interim treatment response were associated with PFS and OS in the univariate analysis. However, only Kimax and interim treatment response were independent influences on PFS and OS in multivariate analysis.

Conclusion: Interim whole-body dynamic 18F-FDG PET/CT Patlak imaging has significant prognostic value in patients with DLBCL. Among them, the interim dynamic parameter Kimax showed the best predictive value for prognosis compared with the interim SUVmax and interim treatment response. The predictive model established by Kimax and the interim treatment response allowed for the accurate stratification of the prognostic risk of DLBCL.

Keywords: 18F- fluorodeoxyglucose; Diffuse large B-Cell lymphoma; Patlak; Whole-body dynamic PET/CT.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
FDG atrial model characterization process. FDG = fluorodeoxyglucose; K1= FDG flow rates for the total metabolic fractions; K2= FDG flow rates for the free (reversible) fractions; K3 = the FDG flow rates for the net uptake (irreversible) fractions; FDG-6-P= FDG-6-phosphate.
Fig. 2
Fig. 2
Receiver operator characteristics (ROC) analysis. Interim TR = interim treatment response; Kimax = the maximum of net flux rate (the maximum value of Patlak slope); SUVmax = the maximum of standard uptake value.
Fig. 3
Fig. 3
A 64-year-old female patient with DLBCL who initially showed n-CR in interim treatment response but had an end-PET suggestive of CR is still alive and free of disease at the 24-month follow-up. The patient had multiple enlarged lymph nodes in the retroperitoneum as seen in the baseline 18F-FDG PET/CT SUV fusion image (a). After receiving 4 courses of R–CHOP treatment, the interim 18F-FDG PET/CT SUV fusion image still showed metabolized lesions at the site, indicating a non-complete response (n-CR) (b). At this time, the MRFDG fusion image did not reveal any significant abnormal FDG metabolism (c). After receiving 4 more courses of chemotherapy, the end-18F-FDG PET/CT SUV fusion image suggested complete response (CR) (Deauville:2 points) (d).
Fig. 4
Fig. 4
Comparison of hazard ratios (positive versus negative groups) and 95% confidence intervals for various interpretation methods, including Kimax and interim treatment response. Kimax = the maximum of net flux rate (the maximum value of Patlak slope); interim TR = interim treatment response; PFS = 2-year progression-free survival; OS = 2-year overall survival.
Fig. 5
Fig. 5
Kaplan-Meier curves of 2-year progression-free survival and 2-year overall survival of diffuse large B-cell lymphoma patients according to Kimax (cutoff, 0.13 μmol min−1·ml−1, a and c) and interim treatment response (b and d). Kimax = the maximum of net flux rate (the maximum value of Patlak slope); Interim TR = interim treatment response; CR = complete remission; n-CR = non-complete remission.
Fig. 6
Fig. 6
2-year progression-free survival (a) and 2-year overall survival (b) according to the predictive model. High: Kimax ≥ 0.13 + n-CR group (high risk group); Low: Kimax < 0.13 + CR group (low risk group); Medium: Kimax≥0.13 + CR group or Kimax < 0.13 + n-CR group (medium risk group).
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