Abstract
AimOur aim was (1) to evaluate the prevalence of steatosis in lymphoma patients and its evolution during treatment; (2) to evaluate the impact of hepatic steatosis on 18F–FDG liver uptake; and (3) to study how hepatic steatosis affects the Deauville score (DS) for discriminating between responders and non-responders.MethodsOver a 1-year period, 358 PET scans from 227 patients [122 diffuse large B cell lymphoma (DLBCL), 57 Hodgkin lymphoma (HL) and 48 Follicular lymphoma (FL)] referred for baseline (n = 143), interim (n = 79) and end-of-treatment (EoT, n = 136) PET scans were reviewed. Steatosis was diagnosed on the unenhanced CT part of PET/CT examinations using a cut-off value of 42 Hounsfield units (HU). EARL-compliant SULmax were recorded on the liver and the tumour target lesion. DS were then computed.ResultsPrevalence of steatosis at baseline, interim and EoT PET was 15/143 (10.5%), 6/79 (7.6%) and 16/136 (11.8%), respectively (p = 0.62).Ten out of 27 steatotic patients (37.0%) displayed a steatotic liver on all examinations. Six patients (22.2%) had a disappearance of hepatic steatosis during their time-course of treatment. Only one patient developed steatosis during his course of treatment. Liver SULmax values were significantly lower in the steatosis versus non-steatotic groups of patients for interim (1.66 ± 0.36 versus 2.15 ± 0.27) and EoT (1.67 ± 0.29 versus 2.17 ± 0.30) PET. CT density was found to be an independent factor that correlated with liver SULmax, while BMI, blood glucose level and the type of chemotherapy regimen were not. Using a method based on this correlation to correct liver SULmax, all DS4 steatotic patients on interim (n = 1) and EoT (n = 2) PET moved to DS3.ConclusionsSteatosis is actually a theoretical but not practical issue in most patients but should be recognised and corrected in appropriate cases, namely, for those patients scored DS4 with a percentage difference between the target lesion and the liver background lower than 30%.
Highlights
Steatosis or non-alcoholic fatty liver disease (NAFLD) is a hepatic complication of the metabolic syndrome and the major cause of hepatic abnormality throughout the world
The aims of the present study were (1) to evaluate the prevalence of hepatic steatosis in lymphoma patients and its evolution across different time points (2) to evaluate the impact of hepatic steatosis on FDG liver uptake in the lymphoma population taking into consideration other known confounding parameters, especially body mass index (BMI) [7] and blood glucose level (BGL) [8]; and (3) to evaluate the potential impact of hepatic steatosis on therapeutic assessment according to the Deauville criteria
Using CTL/S or CTL-S, frequencies were lower in all groups: eight (5.6%), four (5.1%) and 14 (10.2%) cases in baseline, interim and end of the treatment (EoT) PET groups, respectively, for CTL/S and seven (4.9%), four (5.1%) and 11 (8.0%) cases in baseline, interim and EoT PET groups, respectively, for CTLS
Summary
Steatosis or non-alcoholic fatty liver disease (NAFLD) is a hepatic complication of the metabolic syndrome and the major cause of hepatic abnormality throughout the world. It affects 10–24% of the general population in different countries [1]. NAFLD is histologically diagnosed by macrovesicular steatosis in >5% of hepatocytes. NAFLD comprises two main entities: simple steatosis or non-alcoholic fatty liver and nonalcoholic steato-hepatitis (NASH), which is characterised by lobular inflammation and ballooning degeneration. Because of the prevalence of this disease, imaging diagnosis of hepatic steatosis has been evaluated as an alternative to. Eur J Nucl Med Mol Imaging (2018) 45:941–950 invasive histological diagnosis. Several studies have demonstrated that liver attenuation on unenhanced computed tomography (CT) is an efficient tool to screen for moderate-to-severe hepatic steatosis, {corresponding to macrovesicular steatosis of 33% or greater [2]}, using a cut-off value of 42 Hounsfield units (HU) [3]
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