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

• Published in: EJNMMI research 2019-07, Vol.9 (1), p.1-7, Article 65
• Main Authors: Ly, John, Minarik, David, Edenbrandt, Lars, Wollmer, Per, Trägårdh, Elin
• Format: Article
• Language: English
• Subjects: Algorithms; Cardiac Imaging; Classification; Clinical Medicine; Computed tomography; Deauville score; EARL; Fluorine isotopes; Health services; Imaging; Klinisk medicin; Lesions; Lymphoma; Mathematical analysis; Medical and Health Sciences; Medical research; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Nuclear Medicine; Oncology; Organs; Original Research; Orthopedics; PET; Positron emission; Radiologi och bildbehandling; Radiology; Radiology, Nuclear Medicine and Medical Imaging; Reconstruction algorithm; Regularization; Segmentation; Tomography
• ISSN: 2191-219X; 2191-219X
• DOI: 10.1186/s13550-019-0536-3

Background 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). Methods 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. Results There was a significant difference in DS between the QC algorithm and EARL lower /EARL upper ( p