International Benchmark for Total Metabolic Tumor Volume Measurement in Baseline18F-FDG PET/CT of Lymphoma Patients: A Milestone Toward Clinical Implementation

• DOI: 10.2967/jnumed.124.267789
• Publication Date: 2024-08-01T18:46:00Z
• Authors: Ronald Boellaard; Irène Buvat; Christophe Nioche; Luca Ceriani; Anne-Ségolène Cot...; Luca Guerra; Rodney J. Hicks; Salim Kanoun; Carsten Kobe; Annika Loft; Heiko Schöder; Annibale Versari; Conrad-Amadeus Vo...; Gerben J.C. Zweze...; Josée M. Zijlstra; N. George Mikhaeel; Andrea Gallamini; Tarec C. El-Galaly; Christine Hanoun; Stephane Chauvie; Romain Ricci; Emanuele Zucca; Michel Meignan; Sally F. Barrington
• Keywords: Follicular lymphoma

Total metabolic tumor volume (TMTV) is prognostic in lymphoma. However, cutoff values for risk stratification vary markedly, according to the delineation method used. We aimed create a standardized TMTV benchmark dataset&nbsp;allowing be tested and applied as reproducible biomarker. <b>Methods:</b> Sixty baseline ¹⁸F-FDG PET/CT scans were identified with range of disease distributions (20 follicular, 20 Hodgkin, diffuse large B-cell lymphoma). was measured by 12 nuclear medicine experts, each analyzing cases split across subtypes, case processed 3–4 readers. LIFEx or ACCURATE software chosen reader preference. Analysis performed stepwise: TMTV1 automated preselection lesions using an SUV at least 4 3 cm³ single-click removal physiologic uptake; TMTV2 additional reactive bone marrow spleen single clicks; TMTV3 manual editing remove other uptake, if required; TMTV4 optional addition mouse clicks (no threshold). <b>Results:</b> The final (TMTV4) ranged from 8 2,288 cm³, showing excellent agreement among all readers 87% (52/60) difference less than 10% 10 cm³. In 70% cases, equaled TMTV1, requiring no interaction. Differences exclusively related interpretation lesion inclusion high-uptake region removal, not choice software. For 5 differences (&gt;25%) due disagreement about splenic uptake. <b>Conclusion:</b> proposed segmentation enabled highly measurements, minimal interaction patients. exclusion uptake requires definition specific criteria lymphoma subtype. publicly available allows comparison study results could serve reference test improvements approaches.