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Differentiation of HIV-associated lymphoma from HIV-associated reactive adenopathy using quantitative FDG PET and symmetry

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To determine the diagnostic accuracy of a semiautomated 18F-FDG PET/CT measurement of total lesion glycolysis (TLG), maximum and peak standardized uptake value at lean body mass (SUL-Max and SUL-Peak), qualitative estimates of left/right nodal symmetry and FDG uptake for differentiating lymphoma from reactive adenopathy in HIV-infected patients.

Methods

We retrospectively analyzed 41 whole-body 18F-FDG PET/CT studies performed in HIV-infected patients for clinical reasons. The study received institutional review board approval. Of the 41 patients, 19 had biopsy-proven untreated lymphoma, and 22 with reactive adenopathy without malignancy on follow-up were used as controls. Nodal and extranodal visual qualitative metabolic scores, SUL-Max, SUL-Peak, CT nodal size, and PERCIST 1.0 threshold-based TLG and metabolic tumor volume (MTV) were determined. The qualitative intensity of nodal involvement and symmetry of uptake were compared using receiver operator curve (ROC) analysis. HIV plasma viral RNA measurements were also obtained.

Results

All of the quantitative PET metrics performed well in differentiating lymphoma from reactive adenopathy and performed better than qualitative visual intensity scores. The areas under the ROC curves (AUC) were significantly higher for TLG = 0.96, single SUL-Peak = 0.96, single SUL-Max = 0.97, and MTV = 0.96, compared to 0.67 for CT nodal size (p < 0.001). These PET metrics performed best in separating the two populations in aviremic patients, with AUCs of 1 (AUC 0.91 for CT nodal size). TLG, MTV, SUL-Peak and SUL-Max were more reliable markers among viremic individuals, with AUCs between 0.84 and 0.93, compared to other metrics. PET metrics were significantly correlated with plasma viral load in HIV-reactive adenopathy controls. Asymmetrical FDG uptake had an accuracy of 90.4 % for differentiating lymphoma from reactive adenopathy in HIV-infected patients.

Conclusion

Quantitative PET metabolic metrics as well as the qualitative assessment of symmetry of nodal uptake appear to be valuable tools for differentiating lymphoma from reactive adenopathy in HIV-infected patients using FDG PET. These parameters appear more robust in aviremic patients.

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Acknowledgments

We thank Dr. Richard Ambinder for his contribution, which included experimental design and thoughts on clinical relevance. We also thank Judy Buchannan for helping edit and improve the manuscript. The work was supported by a Quantitative Imaging Network grant awarded by the National Cancer Institute (NCI-U-01-CA 140204).

Conflicts of interest

None.

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Authors and Affiliations

  1. Division of Nuclear Medicine, The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Joyce C. Mhlanga, Daniel Durand, Jeffrey P. Leal & Richard L. Wahl

  2. Department of Oncology Biostatistics Division, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Hua-Ling Tsai & Hao Wang

  3. Maryland Infectious Diseases Department, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Christine M. Durand & Richard Moore

  4. Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Richard L. Wahl

Authors
  1. Joyce C. Mhlanga
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  2. Daniel Durand
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  4. Christine M. Durand
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  8. Richard L. Wahl
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Corresponding author

Correspondence to Richard L. Wahl.

Additional information

A related editorial commentary can be found at doi 10.1007/s00259-014-2701-2

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Mhlanga, J.C., Durand, D., Tsai, HL. et al. Differentiation of HIV-associated lymphoma from HIV-associated reactive adenopathy using quantitative FDG PET and symmetry. Eur J Nucl Med Mol Imaging 41, 596–604 (2014). https://doi.org/10.1007/s00259-013-2671-9

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  • DOI: https://doi.org/10.1007/s00259-013-2671-9

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