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Lymphoma Severity and Type Are Associated With Aortic FDG Uptake by 18F-FDG PET/CT Imaging
Charalambos V Vlachopoulos1, Iosif P Koutagiar1, Alexandros T Georgakopoulos2
1Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Insights
Lymphoma severity is linked to increased arterial inflammation, as shown by higher aortic fluorodeoxyglucose (FDG) uptake. This suggests a potential vascular impact of lymphoma, highlighting molecular imaging
Area of Science:
- Cardio-oncology
- Molecular Imaging
- Vascular Inflammation
Background:
- Metabolic disease burden in lymphoma impacts patient outcomes.
- The cardiovascular effects of lymphoma severity are not well understood.
Purpose of the Study:
- To investigate the association between lymphoma's metabolic burden and arterial inflammation.
- To examine arterial fluorodeoxyglucose (FDG) uptake in relation to lymphoma severity.
Main Methods:
- Sixty-two chemotherapy-naïve lymphoma patients and controls underwent 18F-FDG PET-CT imaging.
- Disease severity quantified by metabolic tumor volume (MTV) and total lesion glycolysis.
- Aortic FDG uptake measured using target-to-background ratio (TBR).
Main Results:
- Active lymphoma patients (Hodgkin's and non-Hodgkin's) showed significantly higher aortic TBR compared to controls.
- Aortic TBR was modestly increased in advanced-stage (III-IV) lymphoma.
- Aortic FDG uptake independently correlated with metabolic tumor volume (MTV≥2.5 and MTV≥41%).
Conclusions:
- Aortic wall FDG uptake is associated with lymphoma disease severity.
- This suggests a potential vascular consequence of lymphoma.
- Molecular imaging may play a role in evaluating lymphoma's impact on vasculature in cardio-oncology.
Background:
There is evidence that metabolic disease burden in lymphoma influences patient outcome. However, the impact of disease severity on the cardiovascular system is unknown.
Objectives:
The aim of this study was to examine whether lymphoma is associated with arterial inflammation by investigating the relationship between disease metabolic burden and arterial fluorodeoxyglucose (FDG) uptake.
Methods:
Sixty-two chemotherapy-naïve patients with active Hodgkin's or non-Hodgkin's lymphoma were matched (2:1) to individual control groups of lymphoma patients previously treated and free of active disease. All groups underwent 18F-FDG position emission tomography-computed tomography imaging. Disease severity was quantified by metabolic tumor volume (MTV) and total lesion glycolysis corresponding to standardized uptake values (SUVs) ≥41% or ≥2.5 of the maximum SUV within lymphoma regions, and aortic FDG uptake was quantified through the target-to-background ratio (TBR). Inflammatory and disease severity biomarkers were also measured.
Results:
MTV and total lesion glycolysis measurements were significantly correlated with inflammatory and disease biomarkers. Aortic TBR was higher in patients with active non-Hodgkin's lymphoma compared with control subjects (median difference 0.51; 95% confidence interval [CI]: 0.28 to 0.78; p < 0.001). Similarly, patients with active Hodgkin's lymphoma had higher values of aortic TBR compared with control subjects (median difference 0.31; 95% CI: 0.15 to 0.49; p < 0.001). In addition, aortic TBR was modestly increased in patients with stage III to IV disease compared with those with stage I to II disease (median aortic TBR: 2.23 [interquartile range: 2.01 to 2.54] vs. 2.06 [interquartile range: 1.83 to 2.27; p = 0.050). In multivariable analysis, aortic FDG uptake and MTV≥2.5 values were independently associated (β = 0.425; 95% CI: 0.189 to 0.662; p = 0.001; R2 = 0.208), as were aortic FDG uptake and MTV≥41% (β = 0.407; 95% CI: 0.167 to 0.649, p = 0.001; R2 = 0.191).
Conclusions:
Aortic wall FDG uptake is related with disease severity indicative of a possible vascular effect of lymphoma. This work highlights a new potential role of molecular imaging in cardio-oncology for evaluating disease severity and its consequences on the vasculature.
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