CT-based texture analysis potentially provides prognostic information complementary to interim fdg-pet for patients with hodgkin’s and aggressive non-hodgkin’s lymphomas

Abstract

ObjectivesThe purpose of this study was to investigate the ability of computed tomography texture analysis (CTTA) to provide additional prognostic information in patients with Hodgkin's lymphoma (HL) and high-grade non-Hodgkin's lymphoma (NHL).MethodsThis retrospective, pilot-study approved by the IRB comprised 45 lymphoma patients undergoing routine 18F-FDG-PET-CT. Progression-free survival (PFS) was determined from clinical follow-up (mean-duration: 40 months; range: 10-62 months). Non-contrast-enhanced low-dose CT images were submitted to CTTA comprising image filtration to highlight features of different sizes followed by histogram-analysis using kurtosis. Prognostic value of CTTA was compared to PET FDG-uptake value, tumour-stage, tumour-bulk, lymphoma-type, treatment-regime, and interim FDG-PET (iPET) status using Kaplan-Meier analysis. Cox regression analysis determined the independence of significantly prognostic imaging and clinical features.ResultsA total of 27 patients had aggressive NHL and 18 had HL. Mean PFS was 48.5 months. There was no significant difference in pre-treatment CTTA between the lymphoma sub-types. Kaplan-Meier analysis found pre-treatment CTTA (medium feature scale, p=0.010) and iPET status (p<0.001) to be significant predictors of PFS. Cox analysis revealed that an interaction between pre-treatment CTTA and iPET status was the only independent predictor of PFS (HR: 25.5, 95% CI: 5.4-120, p<0.001). Specifically, pre-treatment CTTA risk stratified patients with negative iPET.ConclusionCTTA can potentially provide prognostic information complementary to iPET for patients with HL and aggressive NHL.Key Points• CT texture-analysis (CTTA) provides prognostic information complementary to interim FDG-PET in Lymphoma. • Pre-treatment CTTA and interim PET status were significant predictors of progression-free survival. • Patients with negative interim PET could be further stratified by pre-treatment CTTA. • Provide precision surveillance where additional imaging reserved for patients at greatest recurrence-risk. • Assists in risk-adapted treatment strategy based on interim PET and CTTA.

Association between textural and morphological tumor indices on baseline PET‐CT and early metabolic response on interim PET‐CT in bulky malignant lymphomas

“…The main limitations of the present study are related to its retrospective design and the limited number of patients. The Hodgkin and non‐Hodgkin patients were pooled in order to maximize the statistical power of the study, as has been done in recent CT‐based textural analysis . Long‐term follow‐up was not available for survival assessment since most of the PET‐CT examinations dated back only a few months when the statistical analysis was conducted.…”

“…More importantly, Ganeshan et al. recently demonstrated that heterogeneity metrics extracted from pretreatment CT provide prognostic information that is complementary to interim PET‐CT and that these metrics are independent predictors of progression‐free survival in both HL and NHL …”

Long-Term Survival Rates of Patients with Stage III–IV Hodgkin Lymphoma According to Age, Sex, Race, and Socioeconomic Status, 1984–2013

“…Although various risk factors may impact prognosis for HL, for instance, patient‐related risk factors that affect outcome of its treatment , prognosis is believed to have improved substantially with advances in therapy, such as chemotherapy , targeted agents such as rituximab , and immunotherapy . Furthermore, the renewed use of diagnostic methods such as computed tomography texture analysis provides prognostic information for HL . These dramatic changes in disease management have transformed HL from an incurable disease to a chronic one .…”

Advanced Hodgkin’s lymphoma: End-of-treatment FDG-PET should be maintained

“…One team showed that textural analysis of baseline CT images are correlated to progression-free survival and can be combined with information from interim-PET [30]. There also is potential for textural analysis of baseline PET images to yield useful information [31,32].…”