Characteristics of 18FDG PET/CT image and the correlation between standard uptake value and some indicators of patient with non hodgkin lymphoma at 103 Military Hospital

To analyze the characteristics of 18FDG-PET/CT image and explore the relevance of the standard uptake value with some prognostic indicators. Subjects and methods: Descriptive, prospective study on 50 patients with a definitive diagnosis of non-Hodgkin lymphoma by 18FDG-PET/CT scans in the Department of Nuclear Medicine, 103 Military Hospital.

CHARACTERISTICS OF 18FDG PET/CT IMAGE AND THE

CORRELATION BETWEEN STANDARD UPTAKE VALUE AND SOME INDICATORS OF PATIENT WITH NON-HODGKIN

LYMPHOMA AT 103 MILITARY HOSPITAL

Nguyen Kim Luu 1 ; Ngo Van Dan 1 ; Ngo Vinh Diep 1

SUMMARY

Objectives: To analyze the characteristics of 18 FDG-PET/CT image and explore the relevance of the standard uptake value with some prognostic indicators Subjects and methods: Descriptive, prospective study on 50 patients with a definitive diagnosis of non-Hodgkin lymphoma by 18 FDG-PET/CT scans in the Department of Nuclear Medicine, 103 Military Hospital Results and conclusion: Standard uptake value index increased in the inguinal node groups (27.2 ± 11.0), abdominal lymph nodes (16.3 ± 8.3), in amydal (18.5 ± 0.7), lower stomach (9.1 ± 6.2) There was a relatively close correlation (r = 0.8) between standard uptake value and cell malignancy and correlation between standard uptake value and international prognosis index risk (r = 0.51)

* Keywords: Non-Hodgkin lymphoma; 18 FDG PET/CT; Standard uptake value

INTRODUCTION

Non-Hodgkin lymphoma (NHL) is a

malignant group of lymphocytes, which

may manifest in lymph nodes or beyond

lymph nodes Following Globocan (2012),

NHL is one of the ten most common

cancers in Vietnam and many other countries

in the world, ranking fifth in terms of

incidence and sixth in mortality after lung,

breast, liver, stomach and colorectal cancers

The disease occurs in all ages, men tend

to get sick more than women

Diagnosis of NHL based on clinical and

subclinical characters Clinical symptoms

include enlarged lymph nodes found in the

neck, upper arm, armpit, groin Lymphoma

can occur in any organ or part of the body

When the disease is in advanced stage, there may be signs of compression, invasion of lymph nodes, tumors such as: protrusion; facial paralysis, numbness, paralysis, paralysis due to compression

of the spinal cord; intestinal obstruction, gastrointestinal bleeding in the case of gastrointestinal tract tumor

Subclinically: Lymph node biopsy to diagnose the disease and classify cell lines Bone marrow biopsy helps determine the invasion of tumor cells into the bone marrow

to help classify and predict prognosis Biochemical testing of tumor markers: high blood lactate dehydrogenase (LDH), increased blood beta2-microglobulin has

a negative prognosis

1 103 Military Hospital

Corresponding author: Ngo Van Dan (dr.danhvqy@gmail.com)

Date received: 07/06/201

Date accepted: 05/08/2019

There are many methods of image

diagnosis such as ultrasound of the neck,

armpit, groin, abdomen to detect the

number, position, size of lymph nodes

and tumors CT, MRI-scans of the chest,

abdomen, cranial and spinal cord to assess

the size of tumors, lymph nodes, position,

degree of invasion 18FDG PET/CT has a

high value for detecting lymph node

lesions, helping to accurately assess the

number, position, size of lymph nodes,

external lymphadenopathy to help determine

the stage of disease more accurately,

follow progress, evaluate treatment response,

monitor relapse after treatment

In this topic, we set the research

problem with the objective of: Assessing

of lymphadenopathy and the relationship

between standard uptake value (SUV) values

and malignancy and prognosis index of NHL

SUBJECTS AND METHODS

1 Subjects

50 patients with a definitive diagnosis

of NHL by histopathology, under inpatient

treatment at the Department of Hematology - Toxic - Radiology and Occupational Disease and Nuclear Medicine Department and taking 18FDG-PET/CT at the Department

of Nuclear Medicine, 103 Military Hospital from June 2016 to August 2018

2 Methods

Descriptive and prospective study The patients were evaluated for the International Prognostic Index (IPI)

PET/CT Trulight (Philip firm) Drug of radioactive substance 18FDG, dosage: 0.14 - 0.15 mCi/kg body weight

On the 18FDG-PET/CT image, there are the largest number of nodes, largest position, size and value SUVs in each group Size, position and SUV value of non-lymph node lesions

The results were statistically processed: average size, average SUV by lymph node group, lymph node position, lymph node group Find correlation between SUV value and malignancy and IPI index of disease NHL multiplication

RESULTS AND DISCUSSION

50 NHL patients with characteristics: Age from 23 to 87 years, average age was 53.8 ± 17.9 Males: 38 and females: 12; male:female ratio = 3.2:1

Table 1: Characteristics of the research group

Characteristics No of patients Percentage (%)

Reason of admission

Symptom B

B 47 94 Cell type

CD20

Percentage of hospitalized patients with symptoms of large nodes (27/50 = 54%), abdominal pain (16/50 = 32%) due to abdominal metastasis, so patients with non-Hodgkin's malignant lymphoma are often given late diagnosis Most patients (47/50 = 94%) were of the invasive B cells, of which 45/50 (90%) had CD20 (+)

Table 2: Location of metastatic lymph nodes and tumors in NHL patients

Metastatic lymph nodes and tumors

No of patients Percentage (%)

Nodes

Tumors

According to Carlos A.B [1], 18FDG

PET/CT can detect metastatic lymphoma

in many different organs such as the brain,

neck, liver, spleen, muscle and skin In

some cases, attention should be paid to

avoid false diagnosis due to physiological

glucose concentration or inflammation after

the patient treated with chemotherapy,

radiation therapy However, the high

concentration of physiological glucose is

usually in the lymph structures in the head

and neck areas and is symmetrical, while malignant lymphocytes are often asymmetrical and significantly higher in SUV values

By retrospective analysis of some research results, Delbeke, Wu L.M and Chen F.Y [2, 7] showed that 18FDG PET/CT in NHL diagnosis had a sensitivity of 91.6% and specificity of 90.3%, higher than MRI There were some claims that these statistics were over 97%

Table 3: Lymph node size and 18FDG concentration (SUV) of lymph nodes

p > 0.05

r = 0.19

The average size of the largest lymph node in each node group was over 2 cm The concentration of glucose SUV increased highly in the inguinal node group (27.2 ± 11.0), abdominal lymph nodes (16.3 ± 8.3), and the overall average was 16.4 ± 7.6 There was no clear correlation between glucose SUV concentration and lymph node size (r = 0.19)

< 0.05

The average size of metastatic tumors was 39.2 ± 14.5 mm, the average SUV value

of metastatic tumors was 14.6 ± 6.5; lower than the average SUV of the node Disseminated B-cell malignant lymphoma is a type of cell that has a rapid division rate,

a strong increase in glucose consumption, therefor the SUV values of lymph nodes and tumors are very high For non-lymphoma tumors, the highest SUV values were found in the amydal (18.5 ± 0.7), the lowest was in the stomach (9.1 ± 6.2) (p < 0.05)

Table 5: SUV concentration of lymph nodes according to histology (n = 45)

p < 0.05

r = 0.8

According to histology, NHL is divided into subgroups with low, medium and high malignancy The above results showed a relatively close correlation (r = 0.8) between

SUV value and cell malignancy According to Carlos A.B [1], the results of 18FDG PET/CT for NHL depend on many factors, one of which is histology SUVs have high values of 16 - 17 in patients with disseminated B-cell NHL or Hodgkin capsule type III; for NHL patients with residential and degree I, II SUVs valued arounded 7 - 9

Table 6: Correlation between SUV and international prognosis index (IPI) prognosis index

IPI index No of patients Average SUV Correlation

r = 0.51

Since 1993, before the IPI, the NHL

prognosis is based on the Ann Arbor

phase [6] But the results of the extra life

expectancy are not really accurate, there

are many differences compared to reality

Therefore, some other risk factors were

added such as patient’s age (> 60),

elevated LDH, PS (> 1) and number of

non-lymph nodes (> 1) The IPI includes

the Ann Arbor phase and these factors

have become a good tool for oncologists

in the progression of NHL patients With

IPI from 0 - 1, the rate of 5-year survival

time was 73%; while with IPI from 4 - 5

this rate was only 26% Table 6 showed

the correlation between SUV and IPI risk

index (r = 0.51) SUVs < 8 belong to a

low-risk group, had a good prognosis, and

NHL patients with SUVs > 14 were at high

risk, with poor prognosis

CONCLUSION

Using 18FDG PET/CT image for 50

patients with NHL, 23/50 patients (46%)

had 1 node group and 27/50 (57%) ≥ 2

node groups Mainly neck lymph nodes (50%), followed by abdominal lymph nodes (32%) and supraclavicular lymph nodes (22%) Metastatic lymphoma was found in 33/50 patients (66%), with 9/50 patients (18%) in the stomach and 16%

in the chest, 14% in the intestine, 10%

in the breasts, uterus, cervix and 8% in

the amydal

The concentration of glucose SUV was increased in the inguinal node group (27.2

± 11.0), abdominal lymph nodes (16.3 ± 8.3), in the amydal (18.5 ± 0.7), the lowest was in the stomach (9.1 ± 6,2)

There was a close correlation (r = 0.8) between SUV value and cell malignancy and between SUV and IPI risk index (r = 0.51) SUVs may have prognostic value for NHL patients

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