PROGNOSTIC VALUE OF THE RADIOMIC CHARACTERISTICS OF 18F-FDG PET/CT IN
CHILDREN WITH HODGKIN'S LYMPHOMA
Dunaykin M.M.1, Shestopalov G.I.1,2, Yadgarov M.Ya.1,3, Kireeva E.D.1,
Kailash Ch.1, Myakova N.V.1, Likar Yu.N.1
1 – Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. Moscow, Russia.
2 – N.I. Pirogov Russian Children’s Clinical Hospital. Moscow, Russia.
3 – Federal Scientific and Clinical Center for Resuscitation and Rehabilitation. Moscow, Russia.
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urpose. To assess the prognostic value of two novel quantitative parameters, Dmax and DmaxVox, which represent the distance between two most distant hypermetabolic foci or voxels within a single lesion in children with Hodgkin’s lymphoma (HL).
Materials and methods. This retrospective analysis included pediatric patients with newly diagnosed HL. All patients underwent 18F-FDG PET/CT at baseline (staging) and after two cycles of polychemotherapy. The parameters Dmax and DmaxVox were measured on baseline PET/CT images using both the freely available LIFEx software and manual measurements, followed by normalization to body surface area (BSA) and patient height. The associations between Dmax, DmaxVox, and their normalized values (SDmax and SDmaxVox) – obtained via both automated and manual segmentation – with event-free survival (EFS) were evaluated.
Results. The parameters Dmax and SDmax could be evaluated in 104 patients (patients with a single lesion or a conglomerate were excluded), while DmaxVox and SDmaxVox were assessed in all 115 patients included in the study. All Dmax and DmaxVox parameters, before and after normalization, demonstrated statistically significant associations with disease stage and correlated with baseline erythrocyte sedimentation rate (ESR) (p < 0.001). No statistically significant correlation was found between BSA-normalized SDmax and EFS. However, height-normalized SDmaxVox values were significantly associated with EFS (p = 0.03). The optimal cut-off points for SDmaxVox LIFEx and SDmaxVox Manual were 0.123 and 0.086, respectively. For both parameters, the negative predictive value exceeded 95%, which suggests that SDmaxVox LIFEx and SDmaxVox Manual may be used to identify HL patients at low risk of relapse or disease progression. All height-normalized parameters (SDmax and SDmaxVox) showed strong and statistically significant intercorrelations.
Discussion. The prognostic utility of Dmax, a relatively simple parameter reflecting the maximum distance between two metabolic foci on PET/CT, has been reported in several previous studies. Before this parameter can be adopted into routine clinical practice, particularly in pediatric settings, a standardized assessment methodology is required. It remains unclear whether patient height and/or body composition influence Dmax values. In our study, there was no significant association between EFS and BSA-normalized SDmax, whereas height-normalized SDmaxVox showed a statistically significant relationship with EFS. All height-normalized parameters (SDmax and SDmaxVox) were significantly correlated with each other. Therefore, in patients with a single lesion, where Dmax cannot be applied, DmaxVox may serve as an appropriate alternative quantitative metric.
Conclusion. This study is the first to comparatively analyze four Dmax-based parameters (SDmax LIFEx, SDmaxVox LIFEx, SDmax Manual, and SDmaxVox Manual) normalized to both body surface area and height, and to determine their prognostic relevance in children with Hodgkin lymphoma. Excellent concordance was observed among all SDmax estimates, supporting their interchangeable use. All height-normalized SDmaxVox parameters demonstrated statistically significant associations with EFS. Our findings confirm the feasibility of assessing Dmax and DmaxVox using manual methods, which may be of practical value for clinical implementation. Nevertheless, these results warrant further investigation and validation in larger patient cohorts.
Keywords: PET/CT scan, Hodgkin's lymphoma, children, metabolic biomarkers, 18F-FDG, Dmax, DmaxVox.
Corresponding author: Dunaykin M.M., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Dunaykin M.M., Shestopalov G.I., Yadgarov M.Ya., Kireeva E.D., Kailash Ch., Myakova N.V., Likar Yu.N. Prognostic value of the radiomic characteristics of 18F-FDG PET/CT in сhildren with hodgkin's lymphoma. REJR 2025; 15(3):232-246. DOI: 10.21569/2222-7415-2025-15-3-232-246.
Received: 18.02.25 Accepted: 30.10.25