Semi-Quantitative Characterization of Post-Transplant Lymphoproliferative Disorder Morphological Subtypes with [18F]FDG PET/CT

Abstract

Background: Post-transplant lymphoproliferative disorder (PTLD) is a complication of organ transplantation classified according to the WHO as nondestructive, polymorphic, monomorphic, and classic Hodgkin Lymphoma subtypes. In this retrospective study, we investigated the potential of semi-quantitative 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) PET/computed tomography (CT)-based parameters to differentiate between the PTLD morphological subtypes. Methods: 96 patients with histopathologically confirmed PTLD and baseline [18F]FDG PET/CT between 2009 and 2019 were included. Extracted semi-quantitative measurements included: Maximum, peak, and mean standardized uptake value (SUVmax, SUVpeak, and SUVmean). Results: Median SUVs were highest for monomorphic PTLD followed by polymorphic and nondestructive subtypes. The median SUVpeak at the biopsy site was significantly higher in monomorphic PTLD (17.8, interquartile range (IQR):16) than in polymorphic subtypes (9.8, IQR:13.4) and nondestructive (4.1, IQR:6.1) (p = 0.04 and p ≤ 0.01, respectively). An SUVpeak ≥ 24.8 was always indicative of a monomorphic PTLD in our dataset. Nevertheless, there was a considerable overlap in SUV across the different morphologies. Conclusion: The median SUVpeak at the biopsy site was significantly higher in monomorphic PTLD than polymorphic and nondestructive subtypes. However, due to significant SUV overlap across the different subtypes, these values may only serve as an indication of PTLD morphology, and SUV-based parameters cannot replace histopathological classification.

The Role of Pre-therapeutic 18F-FDG PET/CT in Pediatric Hemophagocytic Lymphohistiocytosis With Epstein-Barr Virus Infection

“…The present study found that semi-quantitative measurement of metabolic parameters of lymph nodes and extranodal organs might be helpful in distinguishing M-HLH from NM-HLH. It's reported that the FDG uptake of lymph nodes is related with invasiveness of the disease (29). Okano et al found that increased SUV max -LN and SUV max -lesions indicated the lymphomaassociated HLH with cut-off value of 3.3, 5.5, respectively (21).…”

The value of 18F‐FDG PET/CT quantitative indexes in the diagnosis of nondestructive posttransplant lymphoproliferative disorders after pediatric liver transplantation

“…However, it is difficult to distinguish between PTLD-negative cases and nondestructive PTLD cases using SUVpeak due to the significant SUV overlap of the different subtypes. 13 Therefore, it is of significant interest to find an index that can distinguish PTLD-negative cases and nondestructive PTLD cases with high sensitivity, specificity, PPV, NPV, and accuracy; confirm or refute the clinical suspicion of PTLD; and identify suggestive lesions accessible for biopsy. This study reviewed and collected clinical and pathological data of pLT patients who underwent 18 F-FDG PET/CT and lymph node biopsy, explored the indicators that can effectively distinguish PTLD-negative cases and nondestructive PTLD cases, and evaluated their effects.…”

“…Studies have shown that the median peak standardized uptake value (SUVpeak) at the biopsy site of monomorphic PTLD is significantly higher than those of the polymorphic and nondestructive subtypes of PTLD. However, it is difficult to distinguish between PTLD‐negative cases and nondestructive PTLD cases using SUVpeak due to the significant SUV overlap of the different subtypes 13 . Therefore, it is of significant interest to find an index that can distinguish PTLD‐negative cases and nondestructive PTLD cases with high sensitivity, specificity, PPV, NPV, and accuracy; confirm or refute the clinical suspicion of PTLD; and identify suggestive lesions accessible for biopsy.…”

The value of 18 F-FDG PET/CT quantitative indexes in the diagnosis of non-destructive PTLD after pediatric liver transplantation

“…Studies have shown that the median peak standardized uptake value (SUVpeak) at the biopsy site of monomorphic PTLD is significantly higher than those of the polymorphic and non-destructive subtypes of PTLD. However, it is difficult to distinguish between PTLD-negative cases and non-destructive PTLD cases using SUVpeak due to the significant SUV overlap of the different subtypes (13). Therefore, it is of significant interest to find an index that can distinguish PTLD-negative cases and non-destructive PTLD cases with high sensitivity, specificity, PPV, NPV, and accuracy; confirm or refute the clinical suspicion of PTLD; and identify suggestive lesions accessible for biopsy.…”