Prognostic value of [18F]FDG PET/CT in patients with CNS lym
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Current clinical and imaging tools remain suboptimal for predicting treatment response and prognosis in CNS lymphomas. The higher uptake of [18F]FDG PET in patients with CNS lymphoma receiving ibrutinib-based treatments was inversely related to outcome in patients.

53 patients enrolled in a prospective clinical trial and underwent brain PET before receiving single-agent ibrutinib or ibrutinib in combination with methotrexate with or without rituximab. [18F]FDG uptake in these lesions was quantified by drawing PET volumes of interest around up to five [18F]FDG-avid lesions per patient (with uptake greater than the surrounding brain).

Investigators measured standardized uptake values (SUVmax), metabolic tumor volumes, total lesion glycolysis (TLG), and the sum thereof in these lesions. They analyzed the relationship between PET parameters and mutation status, overall response rates, and progression-free survival (PFS). 38 underwent single-agent therapy and 15 received combination therapy.

--On PET, 15/53 patients had no measurable disease. In the other 38 patients, a total of 71 lesions were identified on PET.

--High-intensity [18F]FDG uptake and a larger volume of [18F]FDG-avid disease were inversely related to treatment outcome.

--In univariable analysis, PFS was linearly correlated with all PET parameters, with the stronger association when sum-values were used.

--A multivariable model showed that the risk of progression increased by 9% for every 5-unit increase in sumSUVmax.

Conclusively, higher lesional metabolic parameters are inversely related to outcomes in patients undergoing ibrutinib-based therapies, and sumSUVmax emerged as a strong independent prognostic factor.

European Journal of Nuclear Medicine and Molecular Imaging