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. 2025 Jul;52(9):3180-3189.
doi: 10.1007/s00259-025-07176-4. Epub 2025 Mar 20.

Prognostic impact of metabolic tumor volume using the SUV4.0 segmentation threshold in 1,960 lymphoma patients from prospective LYSA trials

Solène Malmon  1 , Mad-Helenie Elsensohn  2 , Catherine Thieblemont  3   4 , Franck Morschhauser  5 , Olivier Casasnovas  6 , Marc André  7 , Steven Le Gouill  8   9   10 , Yassine Al Tabaa  11 , Paul Bland Durand  12 , Clement Bailly  13   14 , Veronique Edeline  15 , Lavinia Vija  16 , Laetitia Vercellino  17   18 , Romain Ricci  19 , Salim Kanoun #  20 , Anne-Ségolène Cottereau #  21   22
Affiliations

Prognostic impact of metabolic tumor volume using the SUV4.0 segmentation threshold in 1,960 lymphoma patients from prospective LYSA trials

Solène Malmon et al. Eur J Nucl Med Mol Imaging. 2025 Jul.

Abstract

Purpose: This study compared the prognostic value of total metabolic tumor volume (TMTV) in lymphoma measured with the recently proposed SUV4.0 segmentation threshold versus the 41% SUVmax across LYSA trials and its impact on intensity and dissemination PET features.

Methods: A total of 1960 baseline PET/CT scans of Diffuse Large B cell lymphoma (DLBCL), follicular lymphoma (FL) and Hodgkin lymphoma (HL) patients were collected. After a semi-automatic preselection of region of interest, two different segmentation threshold were applied: 41% SUVmax (TMTV41%) and SUV > 4.0 (TMTV4.0).

Results: The correlation between TMTV4.0 and TMTV41% was ρ = 0.90 for DLBCL, ρ = 0.65 for FL and ρ = 0.60 for HL. For SUVmax, SUVpeak, Dmax and Dbulk features, a strong correlation was observed with ρ > 0.95 whatever the lymphoma subtypes. The predictability of TMTV was high and comparable for the two methods with superimposable confidence intervals for the three subtypes. At the 90th percentile TMTV value, the predicted 7-year PFS was 51.13% with TMTV4.0 vs. 49.7% with TMTV41% for DLBCL patients, 45.5% vs. 39.8% for FL patients, and 82.6% vs. 80.5% for HL patients. A minority of patients showed a predicted PFS deviation > 10% between the two methods: 2.33% in DLBCL, 6.51% in FL and 1% in HL.

Conclusion: TMTV measured with the SUV4.0 threshold provides a comparable PFS prediction than the 41%SUVmax method supporting its routine adoption particularly in the diffuse large B cell lymphoma subtype.

Keywords: DLBCL; FL; HL; Lymphoma; TMTV; prognostic factor.

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Conflict of interest statement

Declarations. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Consent to participate: Informed consent was obtained from all individual participants included in the study, as part of prospective trials. Competing interests: All the authors have no relevant financial or non-financial interests to disclose directly related to this work. The authors have the following disclosure, indirectly related to this work to declare: Solene Malmon: no conflicts of interest to disclose. Mad-Helenie Elsensohn: no conflicts of interest to disclose. Catherine Thieblemont. Franck Morschhauser: consultancy: Roche/Genentech; consultancy and membership on an entity’s Board of Directors or advisory committees: Kite/Gilead Sciences, Bristol Myers Squibb, AbbVie, Epizyme, AstraZeneca, Novartis, Genmab; honoraria: Roche/Genentech, Chugai, Takeda. Olivier Casasnovas: consultancy: Roche/Genentech, BMS, Takeda, MSD, Gilead, ADC therapeutics; Research funding: Roche/Genentech, Gilead; honoraria: Roche/Genentech, Takeda, MSD, Abbvie, Beigene. Marc André. Steven Le Gouill. Yassin Altabaa: no conflicts of interest to disclose. Paul Bland Durand: co-founder of PAIRE, consultancy: Pfizer, PAIRE. Clement Bailly: no conflicts of interest to disclose. Veronique Edeline. Lavinia Vija: no conflicts of interest to disclose related to this work. Laetitia Vercellino: consultancy: Kite Gilead, Genmab; hospitality from MSD France, Siemens Healthcare and Sanofi Aventis. Romain Ricci: no conflicts of interest to disclose.Salim Kanoun Salim Kanoun: is the founder of the Pixilib imaging CRO. AS Cottereau: no conflicts of interest to disclose.

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