F-18 FDG PET/CT quantization parameters as predictors of outcome in patients with diffuse large B-cell lymphoma

Eur J Haematol. 2014;92(5):382-9. doi: 10.1111/ejh.12268. Epub 2014 Feb 12.


Aim: We evaluated the prognostic significance of standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) obtained by F-18 FDG PET/CT (PET/CT) in patients with diffuse large B-cell Lymphomas (DLBCL) presenting intermediate IPI score.

Material and methods: Fifty-two patients (61 ± 13 yr) underwent PET/CT before the first-line chemotherapy. The mean SUVmax value, the summed MTV (cm(3) ; 42% threshold), and the cumulative TLG (g) were registered. The patients were followed up 18 months thereafter (range 3-41 months). The PET/CT results were compared to the event-free survival (EFS).

Results: At univariate analysis, SUVmax and lactate dehydrogenase (LDH) levels were predictive, but discordantly. The Kaplan-Meier survival analysis for SUVmax showed a significant better EFS in patients presenting higher values as compared to those having lesser (P = 0.0002, HR 0.13). Summed MTV and cumulative TLG were not suitable for predicting EFS.

Conclusion: Despite the availability of new tools for the quantitative assessment of disease activity on PET/CT, the SUVmax rather than MTV and TLG remains the only predictor for EFS in DLBCL patients. The magnitude of glycolytic activity rather than the amount of metabolically active burden holds a predominant value for determining the response to chemotherapy in DLBCL.

Keywords: DLBCL; PET/CT; glycolytic activity; quantitative assessment; survival.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal, Murine-Derived
  • Antineoplastic Combined Chemotherapy Protocols*
  • Cyclophosphamide
  • Disease-Free Survival
  • Doxorubicin
  • Female
  • Fluorodeoxyglucose F18* / metabolism
  • Follow-Up Studies
  • Glycolysis / drug effects
  • Humans
  • Lymphoma, Large B-Cell, Diffuse / diagnosis*
  • Lymphoma, Large B-Cell, Diffuse / drug therapy
  • Lymphoma, Large B-Cell, Diffuse / mortality
  • Lymphoma, Large B-Cell, Diffuse / pathology
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Positron-Emission Tomography
  • Predictive Value of Tests
  • Prednisone
  • Prognosis
  • Rituximab
  • Tumor Burden / drug effects
  • Vincristine


  • Antibodies, Monoclonal, Murine-Derived
  • R-CHOP protocol
  • Fluorodeoxyglucose F18
  • Rituximab
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone