Diagnostic value of baseline 18FDG PET/CT skeletal textural features in follicular lymphoma

Abstract

At present, 18F-fluorodesoxyglucose (18FDG) positron emission tomography (PET)/computed tomography (CT) cannot be used to omit a bone marrow biopsy (BMB) among initial staging procedures in follicular lymphoma (FL). The additional diagnostic value of skeletal textural features on baseline 18FDG-PET/CT in diffuse large B-cell lymphoma (DLBCL) patients has given promising results. The aim of this study is to evaluate the value of 18FDG-PET/CT radiomics for the diagnosis of bone marrow involvement (BMI) in FL patients. This retrospective bicentric study enrolled newly diagnosed FL patients addressed for baseline 18FDG PET/CT. For visual assessment, examinations were considered positive in cases of obvious bone focal uptakes. For textural analysis, the skeleton volumes of interest (VOIs) were automatically extracted from segmented CT images and analysed using LifeX software. BMB and visual assessment were taken as the gold standard: BMB −/PET − patients were considered as bone-NEGATIVE patients, whereas BMB +/PET −, BMB −/PET + and BMB +/PET + patients were considered bone-POSITIVE patients. A LASSO regression algorithm was used to select features of interest and to build a prediction model. Sixty-six consecutive patients were included: 36 bone-NEGATIVE (54.5%) and 30 bone-POSITIVE (45.5%). The LASSO regression found variance_GLCM, correlation_GLCM, joint entropy_GLCM and busyness_NGLDM to have nonzero regression coefficients. Based on ROC analysis, a cut-off equal to − 0.190 was found to be optimal for the diagnosis of BMI using PET pred.score. The corresponding sensitivity, specificity, PPV and NPV values were equal to 70.0%, 83.3%, 77.8% and 76.9%, respectively. When comparing the ROC AUCs with using BMB alone, visual PET assessment or PET pred.score, a significant difference was found between BMB versus visual PET assessments (p = 0.010) but not between BMB and PET pred.score assessments (p = 0.097). Skeleton texture analysis is worth exploring to improve the performance of 18FDG-PET/CT for the diagnosis of BMI at baseline in FL patients.

Flow cytometry to detect bone marrow involvement by follicular lymphoma

“…We found a poor correlation between FC and PET vis‐à‐vis BMI. Given the low burdens detected in many patients, this finding is expected and aligns with the low sensitivity seen for PET to detect BMI in FL (Faudemer et al, 2021; St‐Pierre et al, 2020). However, it should be noted that recent data suggests that PET may complement (rather than aim to replace) other means of assessing BMI (Faudemer et al, 2021; Nakajima et al, 2020).…”

Radiomics in Oncological PET Imaging: A Systematic Review—Part 2, Infradiaphragmatic Cancers, Blood Malignancies, Melanoma and Musculoskeletal Cancers

“…A total of 24 articles on lymphomas were included in this review [ 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 ], 13 of which studying diffuse large B-cell lymphoma (including 2 studies on gastro-intestinal lymphoma), 3 on follicular lymphoma, 3 on Hodgkin’s lymphoma, 2 on mantle cell lymphoma and 3 on other sub-types of lymphoma. 18F-FDG was the only tracer employed and all studies built radiomic models on baseline, pre-treatment PET images, often including clinical parameters and international prognostic indices.…”

“…Several studies evaluated the role of PET radiomics and AI analysis in blood malignancies [ 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 ]. Lymphoma radiomics on 18F-FDG PET/CT was more often assessed on patients with DLBCL, in retrospective cohorts and for prognostic purposes.…”

CT radiomics to predict Deauville score 4 positive and negative Hodgkin lymphoma manifestations

“…It would also have been desirable to obtain data from a more consistent patient population with a consistent therapy regimen and identical time points of PET/CT. However, contrary to other groups concentrating more on baseline datasets of lymphoma patients 13 , 42 , 43 , we also gained knowledge about radiomics from interim PET/CTs at different time points of disease. Our results should be verified in larger, more consistent patient populations examined on CT scanners from additional vendors to affirm median as a robust feature across scanners and should be validated externally according to Shahzadi 44 supporting clinical applicability.…”