Nuclear Medicine Department, Caen University Hospital, Caen, France.
UNICAEN, INSERM 1086 ANTICIPE, Normandy University, Caen, France.
Sci Rep. 2021 Dec 10;11(1):23812. doi: 10.1038/s41598-021-03278-9.
At present, F-fluorodesoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) cannot be used to omit a bone marrow biopsy (BMB) among initial staging procedures in follicular lymphoma (FL). The additional diagnostic value of skeletal textural features on baseline FDG-PET/CT in diffuse large B-cell lymphoma (DLBCL) patients has given promising results. The aim of this study is to evaluate the value of FDG-PET/CT radiomics for the diagnosis of bone marrow involvement (BMI) in FL patients. This retrospective bicentric study enrolled newly diagnosed FL patients addressed for baseline FDG PET/CT. For visual assessment, examinations were considered positive in cases of obvious bone focal uptakes. For textural analysis, the skeleton volumes of interest (VOIs) were automatically extracted from segmented CT images and analysed using LifeX software. BMB and visual assessment were taken as the gold standard: BMB -/PET - patients were considered as bone- patients, whereas BMB +/PET -, BMB -/PET + and BMB +/PET + patients were considered bone- patients. A LASSO regression algorithm was used to select features of interest and to build a prediction model. Sixty-six consecutive patients were included: 36 bone- (54.5%) and 30 bone- (45.5%). The LASSO regression found variance, correlation, joint entropy and busyness to have nonzero regression coefficients. Based on ROC analysis, a cut-off equal to - 0.190 was found to be optimal for the diagnosis of BMI using PET pred.score. The corresponding sensitivity, specificity, PPV and NPV values were equal to 70.0%, 83.3%, 77.8% and 76.9%, respectively. When comparing the ROC AUCs with using BMB alone, visual PET assessment or PET pred.score, a significant difference was found between BMB versus visual PET assessments (p = 0.010) but not between BMB and PET pred.score assessments (p = 0.097). Skeleton texture analysis is worth exploring to improve the performance of FDG-PET/CT for the diagnosis of BMI at baseline in FL patients.
目前，氟代脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）不能用于滤泡性淋巴瘤（FL）初始分期中省略骨髓活检（BMB）。在弥漫性大 B 细胞淋巴瘤（DLBCL）患者的基线 FDG-PET/CT 上，骨骼纹理特征的附加诊断价值已给出了有前景的结果。本研究旨在评估 FDG-PET/CT 放射组学在诊断 FL 患者骨髓受累（BMI）中的价值。这项回顾性的中心研究纳入了新诊断的 FL 患者，这些患者接受了基线 FDG PET/CT。对于视觉评估，在存在明显的骨骼局灶性摄取的情况下，检查被认为是阳性的。对于纹理分析，从分割 CT 图像中自动提取感兴趣的骨骼体积（VOI），并使用 LifeX 软件进行分析。BMB 和视觉评估被视为金标准：BMB-/-PET-的患者被认为是无骨患者，而 BMB-/+、BMB-/-PET+和 BMB-/+PET+的患者被认为是有骨患者。使用 LASSO 回归算法选择有意义的特征并建立预测模型。共纳入 66 例连续患者：36 例无骨（54.5%）和 30 例有骨（45.5%）。LASSO 回归发现方差、相关性、联合熵和繁忙度的回归系数不为零。基于 ROC 分析，发现 PET pred.score 诊断 BMI 的最佳截断值等于-0.190。相应的敏感性、特异性、PPV 和 NPV 值分别为 70.0%、83.3%、77.8%和 76.9%。当将 ROC AUC 与单独使用 BMB、视觉 PET 评估或 PET pred.score 进行比较时，BMB 与视觉 PET 评估之间存在显著差异（p=0.010），而 BMB 与 PET pred.score 评估之间无显著差异（p=0.097）。骨骼纹理分析值得探索，以提高 FDG-PET/CT 对 FL 患者基线 BMI 诊断的性能。
