Application of 18F-FDG PET/CT in early detection of therapy-associated cardiotoxicity in patients with lymphoma / 中华核医学与分子影像杂志

ABSTRACT

Objective:To explore the role of 18F-fluorodeoxyglucose (FDG) PET/CT in early detection of therapy-associated cardiotoxicity (TACT) in lymphoma patients and to analyze the diagnostic efficacy of different evaluation criteria. Methods:Consecutive patients between November 2009 to October 2018 in Peking University Cancer Hospital were retrospectively enrolled. All patients underwent standard chemotherapy. Myocardial uptake of 18F-FDG pre- and post-treatment were analyzed by visual interpretation and semi-quantitative (maximum standardized uptake value, SUV max) methods. The value of pre-treatment SUV max-heart -post-treatment SUV max-heart (ΔSUV max), %ΔSUV max, and post-treatment SUV max-heart/SUV max-mediastinum, SUV max-heart/SUV max-liver and SUV max-heart/SUV max-background(left gluteal muscle) ratios were calculated. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal cut-off values of those PET/CT imaging criteria for evaluating early TACT of lymphoma, taking electrocardiogram (ECG) positive as the end point. Independent-sample t test and χ2 test were performed. Results:A total of 274 patients (median age was 36-year old), with the male-to-female ratio of 1.85∶1, were included, and 78.1%(214/274) of them had non-Hodgkin′s lymphoma (NHL). After treatment, 55.1%(151/274)of the patients had high myocardial uptake of 18F-FDG (compared with liver uptake), 20.4%(56/274) of them had moderate myocardial uptake (between liver uptake and blood-pool uptake), and 24.5%(67/274) were with equal uptake (less than blood-pool uptake). There were significant differences in myocardial uptake between ECG-positive group ( n=71) and ECG-negative group ( n=203) ( SUV max: 7.77±4.06 vs 5.91±3.04; t=4.045, P<0.01). ROC curves showed that optimal thresholds of post-treatment SUV max-heart, Δ SUV max-heart, %ΔSUV max-heart, and post-treatment SUV max-heart/SUV max-mediastinum, SUV max-heart/SUV max-liver and SUV max-heart/SUV max-background ratios were 9.4, 4.8, 1.4, 5.0, 2.3, 7.0 respectively. The corresponding areas under the curves (AUC) were 0.653, 0.637, 0.612, 0.655, 0.649 and 0.650, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of post-treatment SUV max-heart/SUV max-background ratio were 40.85%(29/71), 82.76%(168/203), 45.31%(29/64), 80.00%(168/210) and 71.90%(197/274). Conclusion:18F-FDG PET/CT can early detect TACT in patients with lymphoma, and if using 7.0 as the threshold of post-treatment SUV max-heart/SUV max- background ratio, the specificity and negative predictive value of 18F-FDG PET/CT for early prediction of TACT are up to 80%.