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Purpose: To evaluate the reliability of the Deauville score (DS) in therapy response assessment and to define the prognostic value of the metabolic response of end of induction (EOI) [ 18 F]FDG PET (PET) in follicular lymphoma patients., Methods: Adult patients with untreated grade 1-3a FL/ stage II-IV enrolled in the multicentre, prospective, phase III FOLL12 trial (NCT02063685) were randomized to receive standard immunochemotherapy followed by rituximab maintenance (standard arm) versus standard immunochemotherapy followed by response-adapted post-induction management (experimental arm). Baseline and EOI PET were mandatory for the study. All PET scans were centralized on the WIDEN® platform and classified according to DS in a blind independent central review. DS1-3 was considered negative (CMR), whereas DS4-5 was considered positive (not CMR). The primary endpoint was PFS. The main secondary endpoint was overall survival (OS)., Results: Overall, 807 follicular lymphoma patients-52% women, 89% stage III-IV disease, 40% with a high-risk FLIPI-2 score (3-5)-were enrolled in the study; 729 (90.4%) baseline and EOI PET were available for the analysis. EOI PET was positive (DS4-5) in 88/729 (12.1%) cases. Overall inter-reviewer agreement on PET pos/neg result was 0.92, while agreement on positive and negative cases was 0.77 and 0.94, respectively. The median follow-up was 69 months; 247 events were registered in the 5-yr follow-up, with a 5-yr PFS of 67% (95%CI: 63%-70%). The 5-yr PFS rate for PET neg (DS1-3) and PET pos (DS4-5) patients was 71% (95%CI: 67%-75%) and 36% (95%CI: 25%-46%), respectively, with HR 3.49 (95%CI: 2.57-4.72). Five-year PFS was worse as DS increased, with 74% (70%-78%), 58% (48%-67%; HR 1.71; p = 0.001)] and 36% (25%-46%; HR 3.88; p < 0.001) in DS1-2, DS3 and DS4-5, respectively. EOI PET maintained its prognostic value in both the standard and experimental arms. In the whole population, 5-yr OS was 94% (95%CI: 92%-96%), with 96% (95%CI: 94-97) and 82% (95%CI: 72%-89%) in EOI PET negative (DS1-3) and positive (DS4-5), respectively (HR 4.48; p < 0.001). When DS was associated with FLIPI-2, patients with DS3 or DS1-2 with high FLIPI-2 (3-5) experienced worse OS than patients with DS1-2 and low FLIPI-2 (1-2) (p = 0.003)., Conclusion: This study shows that DS is a reliable prognostic tool to evaluate EOI PET in follicular lymphoma patients, with prognostic value maintained both in the standard and experimental arms, making metabolic imaging a robust tool to assess response in FL. Moreover, although preliminary, this study provides further information on DS3 patients, who are considered as CMR but show a less favourable PFS than DS1-2 patients., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The major challenge in diagnosing infective endocarditis using fluorine-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) is the high physiological myocardial F-FDG uptake, which may interfere with the detection of pathological uptake. Our aim was to retrospectively analyse the impact of a low-carbohydrate, high-protein, high-fat (LCHPHF) diet starting 72 h before the examination with classic overnight fasting., Methods: We included 92 patients (51 with LCHPHF diet 72 h before the examination and 41 with overnight fast only). Left ventricular (LV) myocardial F-FDG uptake was visually evaluated, to estimate the effect of LCHPHF on myocardial F-FDG uptake, we used a three-point visual scale: 0, negligible uptake and evaluable examination; 1, mild uptake and doubtful examination and 2, intense uptake and not evaluable examination. SUVmax and SUVmean were calculated putting a region of interest on LV myocardium at the level of the largest cardiac footprint and on the site of suspected lesion. Thus, a ratio between SUV of the suspect lesion and SUV of LV was calculated as SUV ratio., Results: By visual assessment, in LCHPHF diet group 46 patients (96.1%) had score 0, 3 patients (5.9%) had score 1 and nobody had score 2. In control group, 23 patients (56.1%) had a score 2, 12 (29.3%) patients obtained a score 1 with a doubtful examination and 6 patients (14.6%) were classified with a score 0 with reportable examination., Conclusion: We demonstrated that an LCHPHF diet can adequately suppress the physiological myocardial uptake leading to a significant improvement in the interpretability and diagnostic accuracy of F-FDG PET/CT in infective endocarditis.

Mucosa-associated lymphoid tissue (MALT) lymphoma involves the mucosa-associated lymphoid tissue potentially arising from any mucosal site, with the stomach as the most common site of involvement. MALT lymphoma is not usually an aggressive disease with a good prognosis except for selected cases. Fluorine-18 ( 18 F) fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is a noninvasive imaging tool used for staging, restaging, and evaluation of the treatment response in non-Hodgkin and Hodgkin lymphoma. However, its effective role in MALT lymphoma is not yet clear. The open question is whether these lymphomas are 18 F-FDG avid or not, with conflicting results reported in the literature. Consequently, the possible clinical role of 18 F-FDG PET/CT for staging and restaging purposes is under debate. The aim of the present review was to analyze the reported data about the role of 18 F-FDG PET or PET/CT in patients with MALT lymphoma. We performed a comprehensive computer literature search of the Scopus, Cochrane, PubMed/MEDLINE, and Embase databases, including articles reported up to August 2019. We included 32 studies that had analyzed 18 F-FDG PET or PET/CT for patients with MALT lymphoma. We analyzed the metabolic behavior of MALT lymphoma using 18 F-FDG PET and the effect of the PET findings in the staging, treatment response evaluation, and prognosis., (Copyright © 2019 Elsevier Inc. All rights reserved.)