P3363Severity of lymphoma is associated with aortic FDG uptake assessed by FDG PET/CT imaging

• Published in: European heart journal Vol. 40; no. Supplement_1
• Main Authors: Solomou, E, Koutagiar, I, Vlachopoulos, C, Georgakopoulos, A, Sioni, A, Giannouli, S, Hontropoulos, S, Stergiou, I, Kafouris, P, Karakitsios, I, Gaitanis, A, Terentes-Printzios, D, Pianou, N, Pouli, A, Tousoulis, D
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01-10-2019
• Subjects: Positron Emission Tomography (PET)
• DOI: 10.1093/eurheartj/ehz745.0239
• EISSN: 1522-9645
• ISSN: 0195-668X

Abstract
Introduction
There is increasing evidence that metabolic disease burden in lymphoma modifies patients' outcome. However, the impact of disease severity on cardiovascular system remains unknown.
Purpose
To investigate whether lymphoma is associated with arterial inflammation by examining the relationship between disease burden and arterial F-18 Fluorodeoxyglucose (FDG) uptake assessed by positron emission tomography/computed tomography (PET/CT) in Hodgkin and non-Hodgkin sub-types.
Methods
Sixty-two patients (43 male, mean age 58±18 years) with Hodgkin (n=29) or non-Hodgkin lymphoma (n=33) underwent FDG PET/CT imaging before chemotherapy. Disease severity was quantified by total metabolic tumor volume (TMTV) that represents the volume exhibiting standard uptake values (SUV) ≥41% or ≥2.5 of maximum SUV within lymphoma regions, while aortic FDG uptake assessment was based on target-to-background ratio (TBR). Serum high sensitivity-C-reactive protein (hs-CRP), white blood count (WBC), ratio of neutrophils to lymphocytes (N/L), albumin and lactic acid dehydrogenase (LDH) values were recorded in all the patients.
Results
TMTV measurements correlated significantly with hs-CRP, WBC, N/L ratio, albumin and LDH. (Table) Patients with advanced stage disease (III-IV) had higher aortic TBR values compared to those with stage I-II disease (median 2.19 interquartile range (1.96–2.54) vs. 2.04 (1.83–2.15) p=0.046 respectively). Aortic TBR was related with N/L ratio (R=0.370, p=0.009), while no significant correlation was observed with either WBC or hs-CRP values (p=0.930 and p=0.296, respectively). There were significant associations between aortic TBR uptake and TMTV values even after adjustment for age, sex, LDH, albumin, N/L ratio, as well as for the number of cardiovascular risk factors of each patient (β=0.353, p=0.001, adjusted R2=0.318 for TMTV41%, β=0.442, p=0.001, adjusted R2=0.269 for TMTV2.5).
Table 1. Pearson correlation between indices of lymphomas' severity and serum biomarkers
PET derived measurements
Hs-CRP
P-value
Neutrophils to lymphocytes ratio
P-value
MTV41%
0.306
0.016
0.317
0.026
MTV2.5
0.312
0.013
0.389
0.006
Albumin
LDH
MTV41%
−0.281
0.044
0.465
<0.001
MTV2.5
−0.419
0.002
0.616
<0.001
Conclusions
Aortic wall FDG uptake is related with disease severity and subtype of lymphoma indicating a vascular effect of lymphoma, as well as a new potential role of molecular imaging in cardio-oncology by evaluation of disease severity and its consequences to vascular beds with a single examination.