Abstract
ObjectivesThe purpose of this study was to investigate the ability of computed tomography texture analysis (CTTA) to provide additional prognostic information in patients with Hodgkin's lymphoma (HL) and high-grade non-Hodgkin's lymphoma (NHL).MethodsThis retrospective, pilot-study approved by the IRB comprised 45 lymphoma patients undergoing routine 18F-FDG-PET-CT. Progression-free survival (PFS) was determined from clinical follow-up (mean-duration: 40 months; range: 10-62 months). Non-contrast-enhanced low-dose CT images were submitted to CTTA comprising image filtration to highlight features of different sizes followed by histogram-analysis using kurtosis. Prognostic value of CTTA was compared to PET FDG-uptake value, tumour-stage, tumour-bulk, lymphoma-type, treatment-regime, and interim FDG-PET (iPET) status using Kaplan-Meier analysis. Cox regression analysis determined the independence of significantly prognostic imaging and clinical features.ResultsA total of 27 patients had aggressive NHL and 18 had HL. Mean PFS was 48.5 months. There was no significant difference in pre-treatment CTTA between the lymphoma sub-types. Kaplan-Meier analysis found pre-treatment CTTA (medium feature scale, p=0.010) and iPET status (p<0.001) to be significant predictors of PFS. Cox analysis revealed that an interaction between pre-treatment CTTA and iPET status was the only independent predictor of PFS (HR: 25.5, 95% CI: 5.4-120, p<0.001). Specifically, pre-treatment CTTA risk stratified patients with negative iPET.ConclusionCTTA can potentially provide prognostic information complementary to iPET for patients with HL and aggressive NHL.Key Points• CT texture-analysis (CTTA) provides prognostic information complementary to interim FDG-PET in Lymphoma.• Pre-treatment CTTA and interim PET status were significant predictors of progression-free survival.• Patients with negative interim PET could be further stratified by pre-treatment CTTA.• Provide precision surveillance where additional imaging reserved for patients at greatest recurrence-risk.• Assists in risk-adapted treatment strategy based on interim PET and CTTA.
Highlights
18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)–computed tomography (CT) is the standard imaging assessment at the end of treatment for patients with Hodgkin’s lymphoma (HL) and diffuse large B-Cell lymphoma (DLBCL) [1, 2], and is recommended for initial staging
Metabolic response demonstrated by PET-CT occurs earlier than anatomical response, and multiple studies have shown that interim PET (iPET) is a strong prognostic indicator in HL and aggressive nonHodgkin’s lymphoma (NHL), outperforming the Prognostic Score and International Prognostic Index [3]
The results from our pilot study demonstrate a potential association between pre-treatment CT texture analysis (CTTA) values from non-contrast enhanced tumour images and progression-free survival (PFS) in patients with HL and aggressive NHL
Summary
18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)–computed tomography (CT) is the standard imaging assessment at the end of treatment for patients with Hodgkin’s lymphoma (HL) and diffuse large B-Cell lymphoma (DLBCL) [1, 2], and is recommended for initial staging. Studies in a range of other tumours have shown that, with appropriate quantitative image analysis, CT can provide prognostic information [4,5,6,7,8,9,10,11] One such analysis method is CT texture analysis (CTTA), which can be applied to images that are acquired in routine clinical practice, including the low-dose CT component of PET-CT [12]. The aim of our study is to investigate the ability of CTTA applied to the low-dose CT component of pre-treatment PET-CT to provide additional prognostic information with specific reference to progression-free survival (PFS) in patients with Hodgkin’s and high-grade non-Hodgkin’s lymphoma, in comparison to FDG uptake on PET and other clinical markers
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
