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Inter-reader agreement of quantitative FDG PET/CT biomarkers in lymphoma : a multicentre evaluation of MTV, TLG and Dmax

Trägårdh, Elin LU orcid ; Lewold, Malin LU ; Urdaneta, Jesus Lopez ; Larsson, Måns ; Enqvist, Olof LU ; Barrington, Sally F. ; Jerkeman, Mats LU ; Edenbrandt, Lars and Sadik, May (2025) In BMC Medical Imaging 25(1).
Abstract

Background: The Deauville score is a key prognostic factor in Hodgkin lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL) during interim and end-of-treatment PET/CT evaluations. However, additional measurements, particularly at baseline, such as metabolic tumour volume (MTV), total lesion glycolysis (TLG), and the maximum distance between hypermetabolic lymphoma lesions (Dmax) may offer enhanced prognostic value. This study evaluates the inter-reader agreement of these metrics to assess their reliability across different physicians. Methods: This study included 117 patients with untreated HL or DLBCL who had baseline [18F]fluorodeoxyglucose PET/CT scans. Nine nuclear medicine physicians independently segmented lymphoma... (More)

Background: The Deauville score is a key prognostic factor in Hodgkin lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL) during interim and end-of-treatment PET/CT evaluations. However, additional measurements, particularly at baseline, such as metabolic tumour volume (MTV), total lesion glycolysis (TLG), and the maximum distance between hypermetabolic lymphoma lesions (Dmax) may offer enhanced prognostic value. This study evaluates the inter-reader agreement of these metrics to assess their reliability across different physicians. Methods: This study included 117 patients with untreated HL or DLBCL who had baseline [18F]fluorodeoxyglucose PET/CT scans. Nine nuclear medicine physicians independently segmented lymphoma lesions using the online platform Recomia (www.recomia.org), without specific instructions beyond identifying lymphoma-related lesions. MTV, TLG, and Dmax were calculated from these segmentations. MTV was defined as the summed volume in cm3, TLG as MTV multiplied by SUVmean and Dmax as the distance between the centroids of the two farthest lesions, measured in the 3D reconstruction. Each patient was segmented by two physicians. Inter-reader agreement was assessed using Spearman correlation coefficients for continuous values and Cohen’s kappa coefficient (κ) for dichotomized values (above/below median). Results: The mean age of the 117 patients was 50 years (standard deviation 19), 39% female. Median (± interquartile range) values were 321 (± 597) cm3 for MTV, 2200 (± 4399) cm3 for TLG, and 35 (± 50) cm for Dmax. Spearman correlations between readers were 0.97 for MTV, 0.98 for TLG and 0.72 for Dmax (all p < 0.01). Agreement on dichotomized values was 95.7% for MTV (κ = 0.91), 97.4% for TLG (κ = 0.95), 83.8% for Dmax (κ = 0.68). Conclusions: MTV and TLG demonstrated good inter-reader reliability, even without standardized segmentation protocols. In contrast, Dmax showed moderate variability. These findings support the robustness of MTV and TLG as quantitative biomarkers. For Dmax to be clinically reliable, clearer segmentation guidelines are essential. Especially, inconsistent inclusion of small lesions that may not contribute significantly to MTV, might affect measurement of disease dissemination.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
FDG PET/CT, Inter-reader variability, Lymphoma, Metabolic tumour burden, Total lesion glycolysis
in
BMC Medical Imaging
volume
25
issue
1
article number
368
publisher
BioMed Central (BMC)
external identifiers
  • pmid:40963126
  • scopus:105016696881
ISSN
1471-2342
DOI
10.1186/s12880-025-01937-1
language
English
LU publication?
yes
id
2af525c3-cd2d-4694-bb91-9fe6f3ff2369
date added to LUP
2025-11-24 13:02:03
date last changed
2025-11-24 13:25:07
@article{2af525c3-cd2d-4694-bb91-9fe6f3ff2369,
  abstract     = {{<p>Background: The Deauville score is a key prognostic factor in Hodgkin lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL) during interim and end-of-treatment PET/CT evaluations. However, additional measurements, particularly at baseline, such as metabolic tumour volume (MTV), total lesion glycolysis (TLG), and the maximum distance between hypermetabolic lymphoma lesions (Dmax) may offer enhanced prognostic value. This study evaluates the inter-reader agreement of these metrics to assess their reliability across different physicians. Methods: This study included 117 patients with untreated HL or DLBCL who had baseline [<sup>18</sup>F]fluorodeoxyglucose PET/CT scans. Nine nuclear medicine physicians independently segmented lymphoma lesions using the online platform Recomia (www.recomia.org), without specific instructions beyond identifying lymphoma-related lesions. MTV, TLG, and Dmax were calculated from these segmentations. MTV was defined as the summed volume in cm<sup>3</sup>, TLG as MTV multiplied by SUVmean and Dmax as the distance between the centroids of the two farthest lesions, measured in the 3D reconstruction. Each patient was segmented by two physicians. Inter-reader agreement was assessed using Spearman correlation coefficients for continuous values and Cohen’s kappa coefficient (κ) for dichotomized values (above/below median). Results: The mean age of the 117 patients was 50 years (standard deviation 19), 39% female. Median (± interquartile range) values were 321 (± 597) cm<sup>3</sup> for MTV, 2200 (± 4399) cm<sup>3</sup> for TLG, and 35 (± 50) cm for Dmax. Spearman correlations between readers were 0.97 for MTV, 0.98 for TLG and 0.72 for Dmax (all p &lt; 0.01). Agreement on dichotomized values was 95.7% for MTV (κ = 0.91), 97.4% for TLG (κ = 0.95), 83.8% for Dmax (κ = 0.68). Conclusions: MTV and TLG demonstrated good inter-reader reliability, even without standardized segmentation protocols. In contrast, Dmax showed moderate variability. These findings support the robustness of MTV and TLG as quantitative biomarkers. For Dmax to be clinically reliable, clearer segmentation guidelines are essential. Especially, inconsistent inclusion of small lesions that may not contribute significantly to MTV, might affect measurement of disease dissemination.</p>}},
  author       = {{Trägårdh, Elin and Lewold, Malin and Urdaneta, Jesus Lopez and Larsson, Måns and Enqvist, Olof and Barrington, Sally F. and Jerkeman, Mats and Edenbrandt, Lars and Sadik, May}},
  issn         = {{1471-2342}},
  keywords     = {{FDG PET/CT; Inter-reader variability; Lymphoma; Metabolic tumour burden; Total lesion glycolysis}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{BMC Medical Imaging}},
  title        = {{Inter-reader agreement of quantitative FDG PET/CT biomarkers in lymphoma : a multicentre evaluation of MTV, TLG and Dmax}},
  url          = {{http://dx.doi.org/10.1186/s12880-025-01937-1}},
  doi          = {{10.1186/s12880-025-01937-1}},
  volume       = {{25}},
  year         = {{2025}},
}