Baseline metabolic tumor architecture in diffuse large B-cell lymphoma defined by total metabolic tumor volume and lesion count: a two-center 18F-fluorodeoxyglucose PET/computed tomography study.

Authors

Lin Lin, Ming Li, Tao He, Hongyue Zhao, Yexin Su, Peng Fu

Published in

Nuclear medicine communications. Jul 29, 2026. Epub Jul 29, 2026.

Abstract

Baseline total metabolic tumor volume (TMTV) is an established 18F-fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT) marker of tumor burden in diffuse large B-cell lymphoma (DLBCL), but it does not show whether disease is concentrated in a few bulky lesions or fragmented across many foci. We evaluated whether combining TMTV with lesion count could define a simple baseline metabolic architecture framework.
We retrospectively analyzed 198 treatment-naive patients with DLBCL from two clinical centers who underwent baseline 18F-FDG PET/CT. Semi-automatic lesion segmentation was followed by reader-driven consensus review. Patients were classified using cohort-median cutoffs for TMTV (59.1 mL) and lesion count (16) into low-burden/low-count (n = 74), high-burden/low-count (n = 23), multifocal low-burden (n = 25), and high-burden disseminated (n = 76) patterns.
Log-transformed TMTV and lesion count were moderately correlated (r = 0.686, R2 = 0.471), indicating related but noninterchangeable dimensions. The four patterns differed in maximum standardized uptake value, total lesion glycolysis, and Dmax (all P < 0.001). Pattern distribution was associated with advanced-stage disease (P = 0.004) and trans-diaphragmatic spread (P = 0.005), but not with stage IV disease (P = 0.273) or extranodal organ involvement (P = 0.683). In advanced-stage patients (n = 149), the patterns remained metabolically distinct, whereas conventional staging variables no longer differed across groups.
The TMTV-lesion count framework captures a visually auditable architectural layer of baseline DLBCL that complements cumulative tumor burden and Ann Arbor staging.

PMID:
42522644
Bibliographic data and abstract were imported from PubMed on 29 Jul 2026.

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