title: CT-based texture analysis potentially provides prognostic information complementary to interim fdg-pet for patients with hodgkin's and aggressive non-hodgkin's lymphomas.
abstract: OBJECTIVE
  The 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).
  
  
  METHODS
  This 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  CTTA can potentially provide prognostic information complementary to iPET for patients with HL and aggressive NHL.
  
  
  CONCLUSIONS
  • 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.
authors.affiliation: Institute of Nuclear Medicine, University College London, Euston Rd, London, UK. b.ganeshan@ucl.ac.uk.
authors.forename: B
authors.initials: B
authors.lastname: Ganeshan
authors.affiliation: Institute of Nuclear Medicine, University College London, Euston Rd, London, UK.
authors.forename: K A
authors.initials: KA
authors.lastname: Miles
authors.affiliation: Human Health Division, Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency (IAEA), Vienna, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Babikir
authors.affiliation: Institute of Nuclear Medicine, University College London, Euston Rd, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Shortman
authors.affiliation: Institute of Nuclear Medicine, University College London, Euston Rd, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Afaq
authors.affiliation: Institute of Nuclear Medicine, University College London, Euston Rd, London, UK.
authors.forename: K M
authors.initials: KM
authors.lastname: Ardeshna
authors.affiliation: Institute of Nuclear Medicine, University College London, Euston Rd, London, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Groves
authors.affiliation: Institute of Nuclear Medicine, University College London, Euston Rd, London, UK.
authors.forename: I
authors.initials: I
authors.lastname: Kayani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006689:Hodgkin Disease / Q000000981:diagnostic imaging*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008228:Lymphoma, Non-Hodgkin / Q000178:diet therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Lymphoma; Positron emission tomography and Computed tomography; Progression-free survival; Risk stratification; Texture analysis