Is contrast material needed after treatment of malignant lymphoma in positron emission tomography/computed tomography?

Nakamoto, Yuji; Nogami, Munenobu; Sugihara, Ryo; Sugimura, Kazuro; Senda, Michio; Togashi, Kaori

doi:10.1007/s12149-010-0429-z

Cited by 11 publications

(11 citation statements)

References 18 publications

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“…Interestingly, a recent publication by Nakamoto et al suggests that PET/CT without contrast-enhanced CT is sufficient for lymphoma surveillance and therefore the use of PET/CT instead of CT surveillance could in fact reduce the overall exposure to ionizing radiation in HL survivors. 28 Attention to the health care costs of PET/CT surveillance is commanded in a period in which massive budget problems in public health care systems are obvious across most of Europe. The price per relapse diagnosed by routine PET/CT was US$ 50,778, which was slightly more than the US$ 38,736 -48,757 reported by Lee et al 20 The total costs of PET/CT surveillance are probably even higher because of the numerous supplementary investigations performed due to false positive PET/CT results.…”

Section: Routine Pet/ct Clinically Indicated Pet/ctmentioning

confidence: 99%

Positron emission tomography/computed tomography surveillance in patients with Hodgkin lymphoma in first remission has a low positive predictive value and high costs

El‐Galaly

Mylam²,

Brown³

et al. 2011

Haematologica

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BackgroundThe value of performing post-therapy routine surveillance imaging in patients with Hodgkin lymphoma is controversial. This study evaluates the utility of positron emission tomography/computed tomography using 2-[18F]fluoro-2-deoxyglucose for this purpose and in situations with suspected lymphoma relapse. Design and MethodsWe conducted a multicenter retrospective study. Patients with newly diagnosed Hodgkin lymphoma achieving at least a partial remission on first-line therapy were eligible if they received positron emission tomography/computed tomography surveillance during follow-up. Two types of imaging surveillance were analyzed: "routine" when patients showed no signs of relapse at referral to positron emission tomography/computed tomography, and "clinically indicated" when recurrence was suspected. ResultsA total of 211 routine and 88 clinically indicated positron emission tomography/computed tomography studies were performed in 161 patients. In ten of 22 patients with recurrence of Hodgkin lymphoma, routine imaging surveillance was the primary tool for the diagnosis of the relapse. Extranodal disease, interim positron emission tomography-positive lesions and positron emission tomography activity at response evaluation were all associated with a positron emission tomography/computed tomography-diagnosed preclinical relapse. The true positive rates of routine and clinically indicated imaging were 5% and 13%, respectively (P=0.02). The overall positive predictive value and negative predictive value of positron emission tomography/computed tomography were 28% and 100%, respectively. The estimated cost per routine imaging diagnosed relapse was US$ 50,778. ConclusionsNegative positron emission tomography/computed tomography reliably rules out a relapse. The high false positive rate is, however, an important limitation and a confirmatory biopsy is mandatory for the diagnosis of a relapse. With no proven survival benefit for patients with a pre-clinically diagnosed relapse, the high costs and low positive predictive value make positron emission tomography/computed tomography unsuitable for routine surveillance of patients with Hodgkin lymphoma.Key words: Hodgkin lymphoma, follow-up, PET/CT, positron emission tomography, relapse, health care costs.Citation: El-Galaly TC, Mylam KJ, Brown P, Specht L, Christiansen I, Munksgaard L, Johnsen HE, Loft A, Bukh A, Iyer V, Nielsen AL and Hutchings M. Positron emission tomography/computed tomography surveillance in patients with Hodgkin lymphoma in first remission has a low positive predictive value and high costs. Haematologica 2012;97(6):931-936.

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Section: Routine Pet/ct Clinically Indicated Pet/ctmentioning

confidence: 99%

Positron emission tomography/computed tomography surveillance in patients with Hodgkin lymphoma in first remission has a low positive predictive value and high costs

El‐Galaly

Mylam²,

Brown³

et al. 2011

Haematologica

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“…We favoured this approach, which is similar to that used by other authors [20,24], because we felt that it was clinically more relevant, particularly with regard to treatment planning. In patients with liver metastases, for instance, knowledge of the affected liver segments, which we used as separate regions in our study, is more relevant for deciding between segmental resection, lobectomy or hemi-hepatectomy, than knowledge of the total number of lesions within the liver, or within each segment.…”

Section: Discussionmentioning

confidence: 98%

“…At present, there is no international consensus as to whether PET/CT, in general, should be performed with contrastenhanced CT, or whether unenhanced full-dose diagnostic or low-dose protocols are sufficient for the morphological confirmation of focal areas of increased tracer accumulation or their assignment to anatomical structures. For a mixed patient population with different types of malignant lymphoma, Nakamoto et al were able to show that intravenous contrast enhancement increases the accuracy of posttherapeutic (18)F-FDG PET/CT only in a limited number of cases (patient-based sensitivity, +4%; specificity, + 1%), and thus concluded that unenhanced low-dose PET/CT may be sufficient for routine diagnostic imaging in such patients [20]. Similar results were reported by Pfluger et al in a lesionbased analysis of patients with malignant melanoma, where the differences in sensitivity between unenhanced and contrast-enhanced (18)F-FDG PET/CT were only 3% in favour of the contrast-enhanced image -no difference was observed in terms of specificity [21].…”

Section: Discussionmentioning

confidence: 99%

Are contrast media required for (68)Ga-DOTATOC PET/CT in patients with neuroendocrine tumours of the abdomen?

et al. 2011

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“…Could a low-dose PET/CT be enough for disease staging, consequently decreasing radiation dose to the patient? Different groups have already studied this topic, 11–14 comparing sensitivity and specificity of a low-dose, noncontrast-enhanced PET/CT with a high-dose ceCT (coregistered with the PET acquisition or independently performed). These studies did not find any significant difference among two CT modalities regarding nodal or extranodal, even a low-dose PET/CT could detect more lesions.…”

Section: Discussionmentioning

confidence: 99%

Low-Dose PET/CT and Full-Dose Contrast-Enhanced CT at the Initial Staging of Localized Diffuse Large B-Cell Lymphomas

Sabaté‐Llobera

Cortés‐Romera

Mercadal

et al. 2016

Clin Med�Insights�Blood�Disord

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Computed tomography (CT) has been used as the reference imaging technique for the initial staging of diffuse large B-cell lymphoma until recent days, when the introduction of positron emission tomography (PET)/CT imaging as a hybrid technique has become of routine use. However, the performance of both examinations is still common. The aim of this work was to compare the findings between low-dose 2-deoxy-2-(18F)fluoro-d-glucose (18F-FDG) PET/CT and full-dose contrast-enhanced CT (ceCT) in 28 patients with localized diffuse large B-cell lymphoma according to PET/CT findings, in order to avoid the performance of ceCT. For each technique, a comparison in the number of nodal and extranodal involved regions was performed. PET/CT showed more lesions than ceCT in both nodal (41 vs. 36) and extranodal localizations (16 vs. 15). Disease staging according to both techniques was concordant in 22 patients (79%) and discordant in 6 patients (21%), changing treatment management in 3 patients (11%). PET/CT determined a better staging and therapeutic approach, making the performance of an additional ceCT unnecessary.

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Is contrast material needed after treatment of malignant lymphoma in positron emission tomography/computed tomography?

Abstract: PET/ceCT yielded more accurate findings than PET/ldCT in a limited number of cases. PET/ldCT may, therefore, be sufficient for routine PET/CT scanning for post-therapeutic assessment or restaging of lymphoma patients.

Cited by 11 publications

References 18 publications

Positron emission tomography/computed tomography surveillance in patients with Hodgkin lymphoma in first remission has a low positive predictive value and high costs

Positron emission tomography/computed tomography surveillance in patients with Hodgkin lymphoma in first remission has a low positive predictive value and high costs

Are contrast media required for (68)Ga-DOTATOC PET/CT in patients with neuroendocrine tumours of the abdomen?

Low-Dose PET/CT and Full-Dose Contrast-Enhanced CT at the Initial Staging of Localized Diffuse Large B-Cell Lymphomas

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