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The frequency of change in five-point scale score with a Bayesian penalised likelihood PET reconstruction algorithm on interim FDG PET-CT and its potential implications for therapy decisions in Hodgkin's lymphoma

Research output: Contribution to journalArticlepeer-review

Manil Subesinghe, H Ilyas, Joel Dunn, Naheed Mir, Ana Duran, N G Mikhaeel, Sally Barrington

Original languageEnglish
JournalClinical Radiology
Early online date1 Nov 2022
Accepted/In press23 Sep 2022
E-pub ahead of print1 Nov 2022

Bibliographical note

Funding Information: The authors thank Mr Luis Alves, Dr Hany S Atallah, Dr Z Chalampalakis, Ms Katherine Chalmers and Mr Nuno Martins for their initial help with this project. This work is supported by core funding from the Wellcome/EPSRC Centre for Medical Engineering at King's College London (WT 203148/Z/16/Z) and the Department of Health via the National Institute for Health and Care Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London. SFB acknowledges support from the National Institute for Health Research and Social Care (NIH; RP-2-16-07-001 ). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIH or the Department of Health and Social Care. Publisher Copyright: © 2022 The Author(s)

King's Authors


Aim: To assess the effect of a Bayesian penalised likelihood (BPL) reconstruction algorithm on the five-point scale (5-PS) score, response categorisation, and potential implications for therapy decisions after interim 2-[ 18F]-fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography (PET)–computed tomography (CT) (iPET-CT) to guide treatment in classical Hodgkin's lymphoma (HL). Materials and methods: The present study included new patients with HL undergoing iPET-CT from 2014–2019 after two cycles of doxorubicin (Adriamycin), bleomycin, vincristine, and dacarbazine (ABVD). Two reporters categorised response using the 5-PS and measured maximum standardised uptake values (SUV max) of the most avid tumour residuum, mediastinal blood pool, and normal liver with ordered subset expected maximisation (OSEM) and BPL reconstructions. Results: Eighty-one iPET-CT examinations were reviewed. Compared with OSEM, BPL increased the 5-PS score by a single score in 18/81 (22.2%) patients. The frequency of potential treatment intensification by changing a score of 3–4 was 13.6% (11/81) and represented 25% (11/44) of patients with a score of 3 on OSEM. All 11 patients remained in remission without a change in therapy (mean 63 months) except one who required second-line treatment for refractory disease. Median SUV max of tumour residuum was significantly higher with BPL compared with OSEM (2.7 versus 2.4, p<<0.0001), whilst liver SUV max was significantly lower for both reporters (up to 6.6%, p<0.0001). Conclusion: BPL PET reconstruction increased the 5-PS score on iPET-CT in 22% of HL patients and can potentially result in unnecessary treatment escalation in over half of these patients.

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