Multicenter Comparison of Contrast-Enhanced FDG PET/CT and 64-Slice Multi-Detector-Row CT for Initial Staging and Response Evaluation at the End of Treatment in Patients With Lymphoma

Objectives: To compare staging correctness between contrast-enhanced FDG PET/ceCT and 64-slice multi-detector-row CT (ceCT64) for initial staging and response evaluation at the end of treatment (EOT) in patients with Hodgkin lymphoma, diffuse large B cell lymphoma (DLBCL), and follicular lymphoma. Methods: This prospective study compared initial staging and response evaluation at EOT. One hundred eighty-one patients were randomly assigned to either ceCT64 or FDG PET/ceCT. A nuclear medicine physician and a radiologist read FDG PET/ceCT scans independently and achieved post hoc consensus, whereas another independent radiologist interpreted ceCT64 separately. The reference standard included all clinical information, all tests, and follow-up. Ethics committees of the participating centers approved the study, and all participants provided written consent. Results: Ninety-one patients were randomized to ceCT64 and 90 to FDG PET/ceCT; 72 had Hodgkin lymphoma, 72 had DLBCL, and 37 had follicular lymphoma. There was excellent correlation between the reference standard and initial staging for both FDG PET/ceCT (kappa = 0.96) and ceCT64 (kappa = 0.84), although evaluation of the response at EOT was excellent only for FDG PET/ceCT (kappa = 0.91). Conclusions: Our study demonstrated satisfactory agreement between FDG PET/ceCT (kappa = 0.96) and ceCT64 (kappa = 0.84) in initial staging compared with the reference standard (P = 0.16). Response evaluation at EOT with FDG PET/ceCT (kappa = 0.91) was superior compared with ceCT64 (kappa = 0.307) (P < 0.001).