Does Delayed-Time-Point Imaging Improve 18F-FDG-PET in Patients With MALT Lymphoma?

Purpose: To determine whether in patients with extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue lymphoma (MALT), delayed-time-point 2-F-18-fluoro-2-deoxy-D-glucose-positron emission tomography (F-18-FDG-PET) performs better than standard-time-point F-18-FDG-PET. Materials and Methods: Patients with untreated histologically verified MALT lymphoma, who were undergoing pretherapeutic F-18-FDG-PET/computed tomography (CT) and consecutive F-18-FDG-PET/magnetic resonance imaging (MRI), using a single F-18-FDG injection, in the course of a larger-scale prospective trial, were included. Region-based sensitivity and specificity, and patient-based sensitivity of the respective F-18-FDG-PET scans at time points 1 (45-60 minutes after tracer injection, TP1) and 2 (100-150 minutes after tracer injection, TP2), relative to the reference standard, were calculated. Lesion-to-liver and lesion-to-blood SUVmax (maximum standardized uptake values) ratios were also assessed. Results: F-18-FDG-PET at TP1 was true positive in 15 o f 23 involved regions, and F-18-FDG-PET at TP2 was true-positive in 20 of 23 involved regions; no false-positive regions were noted. Accordingly, region-based sensitivities and specificities were 65.2% (confidence interval [CI], 45.73%-84.67%) and 100% (CI, 100%-100%) for F-18-FDG-PET at TP1; and 87.0% (CI, 73.26%-100%) and 100% (CI, 100%-100%) for F-18-FDG-PET at TP2, respectively. FDG-PET at TP1 detected lymphoma in at least one nodal or extranodal region in 7 of 13 patients, and F-18-FDG-PET at TP2 in 10 of 13 patients; accordingly, patient-based sensitivity was 53.8% (CI, 26.7%-80.9%) for F-18-FDG-PET at TP1, and 76.9% (CI, 54.0%-99.8%) for 18F-FDG-PET at TP2. Lesion-to-liver and lesion-to-blood maximum standardized uptake value ratios were significantly lower at TP1 (ratios, 1.05 +/- 0.40 and 1.52 +/- 0.62) than at TP2 (ratios, 1.67 +/- 0.74 and 2.56 +/- 1.10; P = 0.003 and P = 0.001). Conclusions: Delayed-time-point imaging may improve F-18-FDG-PET in MALT lymphoma.