Utility of 18F-FDG PET/CT metabolic parameters on post-transplant lymphoproliferative disorder diagnosis

Guoying Zhang; Jie Shen; Tianpeng Hu; Wei Zheng; Qiang Jia; Jian Tan; Zhaowei Meng

doi:10.1007/s12149-025-02016-9

Utility of ¹⁸F-FDG PET/CT metabolic parameters on post-transplant lymphoproliferative disorder diagnosis

Ann Nucl Med. 2025 Jan 18. doi: 10.1007/s12149-025-02016-9. Online ahead of print.

Authors

Guoying Zhang^{1

2}, Jie Shen³, Tianpeng Hu³, Wei Zheng¹, Qiang Jia¹, Jian Tan¹, Zhaowei Meng^{4

5}

Affiliations

¹ Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, 300052, China.
² Department of Ultrasound, Tianjin First Central Hospital, Tianjin, 300192, China.
³ Department of Nuclear Medicine, Tianjin First Central Hospital, Tianjin, 300192, China.
⁴ Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, 300052, China. [email protected].
⁵ Tianjin Key Lab of Functional Imaging and Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China. [email protected].

PMID: 39826002
DOI: 10.1007/s12149-025-02016-9

Abstract

Objective: Using ¹⁸F-FDG PET/CT metabolic parameters to differentiate post-transplant lymphoproliferative disorder (PTLD) and reactive lymphoid hyperplasia (RLH), and PTLD subtypes.

Methods: ¹⁸F-FDG PET/CT and clinical data from 63 PTLD cases and 19 RLH cases were retrospectively collected. According to the 2017 WHO classification, PTLD was categorized into four subtypes: nondestructive (ND-PTLD), polymorphic (P-PTLD), monomorphic (M-PTLD), and classic Hodgkin. Metabolic parameters included maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and at different thresholds of SUVmax (2.5 and 41%), as well as gross tumor volume (GTV) was also collected. Nonparametric test and receiver operating characteristic (ROC) curves were used for statistics.

Results: There were 42 ND-PTLD patients, 7 P-PTLD patients, and 14 M-PTLD patients. Ki-67 was significantly correlated with all metabolic parameters (P all < 0.01). SUVmean, SUVmax, MTV, TLG and GTV were all highest in M-PTLD, followed by P-PTLD, ND-PTLD, and RLH. ROC curves showed ¹⁸F-FDG PET/CT metabolic parameters all had moderate diagnostic efficacy in differentiating between PTLD and RLH, the area under the curves (AUC) range from 0.682 to 0.747. Diagnostic efficacy for P-PTLD + M-PTLD showed excellent performance (AUC for RLH + ND-PTLD vs P-PTLD + M-PTLD was 0.848 for SUVmax, 0.846 for SUVmean_41%, 0.834 for SUVmean_2.5, and 0.819 for GTV). For MTV_41%, TLG _41%, MTV_2.5, TLG_2.5, the AUC was 0.676, 0.761, 0.761, 0.787, respectively.

Conclusion: ¹⁸F-FDG PET/CT metabolic parameters at different thresholds of SUVmax (2.5 and 41%) exhibited comparable diagnostic efficacy for PTLD and its subtypes. All metabolic parameters demonstrated moderate diagnostic efficacy in distinguishing PTLD and RLH. SUVmax, SUVmean_41%, SUVmean_2.5 and GTV showed excellent performance in diagnosing P-PTLD + M-PTLD.

Keywords: 18F-FDG PET/CT; Diagnostic efficacy; Metabolic parameters; PTLD.

Abstract

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