The use of a proposed updated EARL harmonization of 18F-FDG PET-CT in patients with lymphoma yields significant differences in Deauville score compared with current EARL recommendations
Open accessAbstract
The Deauville score (DS) is a clinical tool, based on the comparison between lesion and reference organ uptake of 18 F-fluorodeoxyglucose (FDG), used to stratify patients with lymphoma into categories reflecting their disease status. With a plethora of positron emission tomography with computed tomography (PET-CT) hard- and software algorithms, standard uptake value (SUV) in lesions and reference organs may differ which affects DS classification and therefore medical treatment. The EANM Research Ltd. (EARL) harmonization program from the European Association of Nuclear Medicine (EANM) partly mitigates this issue, but local preferences are common in clinical practice. We have investigated the discordance in DS calculated from patients with lymphoma referred for 18 F-FDG PET-CT reconstructed with three different algorithms: the newly introduced block-sequential regularization expectation-maximization algorithm commercially sold as Q. Clear (QC, GE Healthcare, Milwaukee, WI, USA), compliant with the newly proposed updated EARL recommendations, and two settings compliant with the current EARL recommendations (EARL lower and EARL upper , representing the lower and upper limit of the EARL recommendations). Fifty-two patients with non-Hodgkin and Hodgkin lymphoma were included (18 females and 34 males). Segmentation of mediastinal blood pool and liver were semi-automatically performed, whereas segmentation of lesions was done manually. From these segmentations, SUV max and SUV peak were obtained and DS calculated. There was a significant difference in DS between the QC algorithm and EARL lower /EARL upper ( p < 0.0001 for both) but not between EARL lower and EARL upper ( p = 0.102) when SUV max was used. For SUV peak , there was a significant difference between QC and EARL lower ( p = 0.001), but not for QC vs EARL upper ( p = 0.071) or EARL lower vs EARL upper ( p = 0.102). Five non-responders (DS 4–5) for QC were classified as responders (DS 1–3) when EARL lower /EARL upper was used, both when SUV max and SUV peak were investigated. Using the proposed updated EARL recommendations compared with the current recommendations will significantly change DS classification. In select cases, the discordance would affect the choice of medical treatment. Specifically, the current EARL recommendations were more often prone to classify patients as responders.
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In a study on 52 patients with lymphoma, 5 patients undergoing [18F]FDG-PET for restaging were divergently classified as non-responders (Deauville score 4-5) with PL reconstruction but as responders (Deauville 1-3) with OSEM.
“In a study on 52 patients with lymphoma, 5 patients undergoing [18F]FDG-PET for restaging were divergently classified as non-responders (Deauville score 4–5) with PL reconstruction but as responders (Deauville 1–3) with OSEM (without TOF or PSF; compliant with the EARL1 standard) [176].”
From Influences on PET Quantification and Interpretation (2022) · cites this paper as [176]
The Results (Patients and Quantitative analysis; pages unavailable) report 52 patients and five QC non-responders (Deauville 4–5) classified as responders (Deauville 2–3) with EARL reconstruction. The Methods (PET-CT acquisition and reconstruction parameters; page unavailable) identify QC as Q.Clear and the EARL reconstructions as OSEM without resolution recovery or time of flight. The study included baseline, interim, end-of-treatment and suspected-recurrence scans; it does not identify all five reclassified patients as undergoing restaging. (LLM, conf=0.84)
Experimental — accuracy not yet measuredBoth SUV measurements and visual Deauville criteria may be affected by image reconstruction, such as PL reconstruction.
“However, both SUV measurements and visual Deauville criteria may be affected by image reconstruction, such as PL reconstruction [176].”
From Influences on PET Quantification and Interpretation (2022) · cites this paper as [176]
The Methods (PET-CT acquisition and reconstruction parameters; Image analysis) compare different reconstruction algorithms and calculate Deauville scores from SUVmax and SUVpeak. The Results (Quantitative analysis) show that those scores can differ by reconstruction. The paper does not assess visually assigned Deauville criteria, so that part of the claim is not established. (LLM, conf=0.86)
Experimental — accuracy not yet measured
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Additional file 1 of Deep progressive learning achieves whole-body low-dose 18F-FDG PET imaging
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- Authors
- Ly, J., Minarik, D., Edenbrandt, L., Wollmer, P., & Trägårdh, E.
- Affiliations
- Lund University (SE)
- Sahlgrenska University Hospital (SE)
- Corresponding author
- Ly, John
- Venue
- EJNMMI Research
- Published
- 2019-07-25
- Volume
- 9
- Issue
- 1
- Pages
- 65-65
- ISSN
- 2191-219X (ISSN-L)
- PMC
- PMC6658640
- OpenAlex
- W2963708288
- Cited by
- 31
- References
- 15
- Citations by year
- 2026: 3 · 2024: 1 · 2023: 6 · 2022: 9 · 2021: 3 · 2020: 7 · 2019: 2
- FWCI
- 3.47
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- EJNMMI Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Knut och Alice Wallenbergs Stiftelse
- Skåne County Council's Research and Development Foundation
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
- Health Sciences › Medicine › Pathology and Forensic Medicine › Lymphoma Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Keywords
- Deauville score, 18F-FDG PET/CT, non-Hodgkin lymphoma, Hodgkin's disease, Q.Clear, standardized uptake value, SUVmax, SUVpeak, treatment response classification
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