title: FDG-PET Response Prediction in Pediatric Hodgkin's Lymphoma: Impact of Metabolically Defined Tumor Volumes and Individualized SUV Measurements on the Positive Predictive Value.
abstract: BACKGROUND
  In pediatric Hodgkin's lymphoma (pHL) early response-to-therapy prediction is metabolically assessed by (18)F-FDG PET carrying an excellent negative predictive value (NPV) but an impaired positive predictive value (PPV). Aim of this study was to improve the PPV while keeping the optimal NPV. A comparison of different PET data analyses was performed applying individualized standardized uptake values (SUV), PET-derived metabolic tumor volume (MTV) and the product of both parameters, termed total lesion glycolysis (TLG);
  
  
  METHODS
  One-hundred-eight PET datasets (PET1, n = 54; PET2, n = 54) of 54 children were analysed by visual and semi-quantitative means. SUVmax, SUVmean, MTV and TLG were obtained the results of both PETs and the relative change from PET1 to PET2 (Δ in %) were compared for their capability of identifying responders and non-responders using receiver operating characteristics (ROC)-curves. In consideration of individual variations in noise and contrasts levels all parameters were additionally obtained after threshold correction to lean body mass and background;
  
  
  RESULTS
  All semi-quantitative SUV estimates obtained at PET2 were significantly superior to the visual PET2 analysis. However, ΔSUVmax revealed the best results (area under the curve, 0.92; p < 0.001; sensitivity 100%; specificity 85.4%; PPV 46.2%; NPV 100%; accuracy, 87.0%) but was not significantly superior to SUVmax-estimation at PET2 and ΔTLGmax. Likewise, the lean body mass and background individualization of the datasets did not impove the results of the ROC analyses;
  
  
  CONCLUSIONS
  Sophisticated semi-quantitative PET measures in early response assessment of pHL patients do not perform significantly better than the previously proposed ΔSUVmax. All analytical strategies failed to improve the impaired PPV to a clinically acceptable level while preserving the excellent NPV.
authors: Department of Nuclear Medicine (KME), Forschungszentrum Jülich, Medical Faculty, Heinrich-Heine-University Düsseldorf, Jülich, 52426, Germany. amrelsayed79@yahoo.com.
authors: Amr Elsayed M
authors: AE
authors: Hussien
authors: Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University Magdeburg, Magdeburg, 39120, Germany. christian.furth@med.ovgu.de.
authors: Christian
authors: C
authors: Furth
authors: Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, 40225, Germany. stefan.schoenberger@ukb.uni-bonn.de.
authors: Stefan
authors: S
authors: Schönberger
authors: Department of Pediatric Oncology and Hematology, Charité Campus Virchow, Humboldt-University Berlin, Berlin, 13353, Germany. patrick.hundsdoerfer@charite.de.
authors: Patrick
authors: P
authors: Hundsdoerfer
authors: Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University Magdeburg, Magdeburg, 39120, Germany. ingo.steffen@charite.de.
authors: Ingo G
authors: IG
authors: Steffen
authors: Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University Magdeburg, Magdeburg, 39120, Germany. holger.amthauer@med.ovgu.de.
authors: Holger
authors: H
authors: Amthauer
authors: Department of Nuclear Medicine (KME), Forschungszentrum Jülich, Medical Faculty, Heinrich-Heine-University Düsseldorf, Jülich, 52426, Germany. nuk@uni-duesseldorf.de.
authors: Hans-Wilhelm
authors: HW
authors: Müller
authors: Department of Nuclear Medicine (KME), Forschungszentrum Jülich, Medical Faculty, Heinrich-Heine-University Düsseldorf, Jülich, 52426, Germany. h.hautzel@fz-juelich.de.
authors: Hubertus
authors: H
authors: Hautzel
references: J Nucl Med. 2004 Sep;45(9):1519-27
references: 15347719
references: J Clin Oncol. 2005 Jul 20;23 (21):4652-61
references: 15837965
references: Klin Padiatr. 2003 May-Jun;215(3):139-45
references: 12838937
references: Eur J Nucl Med Mol Imaging. 2013 Jan;40(2):166-74
references: 23151911
references: Int J Radiat Oncol Biol Phys. 2001 Dec 1;51(5):1209-18
references: 11728679
references: Ann Surg Oncol. 2010 Jan;17 (1):115-22
references: 19826877
references: J Clin Oncol. 2007 Feb 10;25(5):579-86
references: 17242396
references: J Nucl Med. 2009 May;50 Suppl 1:11S-20S
references: 19380405
references: J Nucl Med. 1999 Nov;40(11):1771-7
references: 10565769
references: Blood. 2006 Jan 1;107(1):52-9
references: 16150944
references: J Nucl Med. 1997 Aug;38(8):1186-91
references: 9255146
references: Nucl Med Commun. 2001 Oct;22(10 ):1077-81
references: 11567179
references: J Nucl Med. 2009 May;50 Suppl 1:122S-50S
references: 19403881
references: J Pediatr Hematol Oncol. 2006 May;28(5):300-6
references: 16772881
references: Eur J Nucl Med Mol Imaging. 2002 Dec;29(12 ):1639-47
references: 12458399
references: Radiology. 1995 Jul;196 (1):167-73
references: 7784562
references: J Nucl Med. 2006 Jun;47(6):1059-66
references: 16741317
references: Onkologie. 2003 Oct;26(5):489-93
references: 14605468
references: Mol Imaging Biol. 2002 Mar;4(2):171-8
references: 14537140
references: J Clin Oncol. 2009 Sep 10;27(26):4385-91
references: 19667276
references: J Nucl Med. 2012 Jan;53(1):12-20
references: 22213819
references: J Clin Oncol. 2007 Aug 20;25(24):3746-52
references: 17646666
references: Eur J Nucl Med Mol Imaging. 2005 Mar;32(3):294-301
references: 15791438
references: J Nucl Med. 2008 Nov;49(11):1804-8
references: 18927325
references: Klin Padiatr. 2011 Nov;223(6):315-9
references: 22012607
references: J Pediatr Hematol Oncol. 2006 Aug;28(8):501-12
references: 16912590
references: Biometrics. 1988 Sep;44(3):837-45
references: 3203132
references: Blood. 2008 Nov 15;112(10 ):3989-94
references: 18757777
references: J Nucl Med. 2004 May;45(5):784-8
references: 15136627
references: Radiology. 1993 Dec;189(3):847-50
references: 8234714
references: Eur J Nucl Med Mol Imaging. 2010 Jul;37(7):1408-25
references: 19936745
references: Pediatr Blood Cancer. 2012 Sep;59(3):475-80
references: 22190514
references: Ann Oncol. 2011 May;22(5):1198-203
references: 20966182
references: Leuk Lymphoma. 2009 Nov;50(11):1753-6
references: 19863178
references: J Nucl Med. 2007 Sep;48(9):1449-58
references: 17704250
references: Eur J Nucl Med Mol Imaging. 2014 Jul;41(7):1301-8
references: 24604592
references: Phys Med Biol. 2012 Nov 7;57(21):R119-59
references: 23073343
references: Nucl Med Commun. 2008 Jun;29(6):521-6
references: 18458598
references: Klin Padiatr. 2004 May-Jun;216(3):150-6
references: 15175959
references: Clin Cancer Res. 2004 Jul 15;10 (14 ):4709-16
references: 15269143