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Baseline metabolic tumor architecture in diffuse large B-cell lymphoma defined by total metabolic tumor volume and
1Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin.
Objective:
Baseline total metabolic tumor volume (TMTV) is an established 18 F-fluorodeoxyglucose PET/computed tomography ( 18 F-FDG PET/CT) marker of tumor burden in diffuse large B-cell lymphoma (DLBCL), but it does not show whether disease is concentrated in a few bulky lesions or fragmented across many foci. We evaluated whether combining TMTV with lesion count could define a simple baseline metabolic architecture framework.
Methods:
We retrospectively analyzed 198 treatment-naive patients with DLBCL from two clinical centers who underwent baseline 18 F-FDG PET/CT. Semi-automatic lesion segmentation was followed by reader-driven consensus review. Patients were classified using cohort-median cutoffs for TMTV (59.1 mL) and lesion count (16) into low-burden/low-count ( n = 74), high-burden/low-count ( n = 23), multifocal low-burden ( n = 25), and high-burden disseminated ( n = 76) patterns.
Results:
Log-transformed TMTV and lesion count were moderately correlated ( r = 0.686, R2 = 0.471), indicating related but noninterchangeable dimensions. The four patterns differed in maximum standardized uptake value, total lesion glycolysis, and Dmax (all P < 0.001). Pattern distribution was associated with advanced-stage disease ( P = 0.004) and trans-diaphragmatic spread ( P = 0.005), but not with stage IV disease ( P = 0.273) or extranodal organ involvement ( P = 0.683). In advanced-stage patients ( n = 149), the patterns remained metabolically distinct, whereas conventional staging variables no longer differed across groups.
Conclusion:
The TMTV-lesion count framework captures a visually auditable architectural layer of baseline DLBCL that complements cumulative tumor burden and Ann Arbor staging.
