Evaluation of diffuse large B-cell lymphoma patients with 64-slice multidetector computed tomography versus 18FDG positron emission tomography/computed tomography in initial staging and restaging after treatment

Abstract Background and objectives To prospectively compare the accuracy in initial staging and end-of-treatment restaging of diffuse large B-cell lymphoma (DLBCL) between 64-slice multidetector computed tomography (64MDCT) and 18FDG positron emission tomography/computed tomography (18FGD PET/CT) with intravenous contrast injection. Material and methods Randomized and blind controlled clinical multicentric trial that included biopsy-proven DLBCL patients. Seventy-two patients from five different hospitals in the region of Madrid, Spain, were enrolled in the study between January 2012 and June 2015. Thirty-six were randomly allocated to 18 FDG PET/TC and the other 36–64MDCT for initial staging and end-of-treatment restaging. A nuclear medicine physician and a radiologist independently analyzed 18 FDG PET/TC images and reached an agreement post hoc. 64MDCT images were separately evaluated by a different radiologist. Every set of images was compared to the reference standard that included clinical data, complementary tests and follow-up. The study was approved by participating centres’ ethics committees and written informed consent was obtained from all the participants. Results A good agreement was observed between both diagnostic techniques and the reference standard in initial staging [ 18 FDG PET/CT ( k  = 0.5) and 64MDCT ( k  = 0.6)], although only the 18 FDG PET/TC showed a good agreement with the reference standard for the end-of-treatment restaging ( k  = 0.7). Conclusion In DLBCL, both 18 FDG PET/TC and 64MDCT have shown good agreement with the reference standard in initial staging. Nevertheless, 18 FDG PET/CT has shown to be superior to 64MDCT in end-of-treatment response assessment.