To explore the role of ¹⁸F-fluorodeoxyglucose (FDG) PET/CT in early detection of therapy-associated cardiotoxicity (TACT) in lymphoma patients and to analyze the diagnostic efficacy of different evaluation criteria.

Consecutive patients between November 2009 to October 2018 in Peking University Cancer Hospital were retrospectively enrolled. All patients underwent standard chemotherapy. Myocardial uptake of ¹⁸F-FDG pre- and post-treatment were analyzed by visual interpretation and semi-quantitative (maximum standardized uptake value, SUV_max) methods. The value of pre-treatment SUV_max-heart -post-treatment SUV_max-heart (ΔSUV_max), %ΔSUV_max, and post-treatment SUV_max-heart/SUV_{max-mediastinum}, SUV_max-heart/SUV_max-liver and SUV_max-heart/SUV_{max-background(left gluteal muscle)} ratios were calculated. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal cut-off values of those PET/CT imaging criteria for evaluating early TACT of lymphoma, taking electrocardiogram (ECG) positive as the end point. Independent-sample t test and χ² test were performed.

A total of 274 patients (median age was 36-year old), with the male-to-female ratio of 1.85∶1, were included, and 78.1%(214/274) of them had non-Hodgkin′s lymphoma (NHL). After treatment, 55.1%(151/274)of the patients had high myocardial uptake of ¹⁸F-FDG (compared with liver uptake), 20.4%(56/274) of them had moderate myocardial uptake (between liver uptake and blood-pool uptake), and 24.5%(67/274) were with equal uptake (less than blood-pool uptake). There were significant differences in myocardial uptake between ECG-positive group (n=71) and ECG-negative group (n=203) ( SUV_max: 7.77±4.06 vs 5.91±3.04; t=4.045, P<0.01). ROC curves showed that optimal thresholds of post-treatment SUV_max-heart, Δ SUV_max-heart, %ΔSUV_max-heart, and post-treatment SUV_max-heart/SUV_{max-mediastinum}, SUV_max-heart/SUV_max-liver and SUV_max-heart/SUV_{max-background} ratios were 9.4, 4.8, 1.4, 5.0, 2.3, 7.0 respectively. The corresponding areas under the curves (AUC) were 0.653, 0.637, 0.612, 0.655, 0.649 and 0.650, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of post-treatment SUV_max-heart/SUV_{max-background} ratio were 40.85%(29/71), 82.76%(168/203), 45.31%(29/64), 80.00%(168/210) and 71.90%(197/274).

¹⁸F-FDG PET/CT can early detect TACT in patients with lymphoma, and if using 7.0 as the threshold of post-treatment SUV_max-heart/SUV_{max- background} ratio, the specificity and negative predictive value of ¹⁸F-FDG PET/CT for early prediction of TACT are up to 80%.

Cardiotoxicity; Lymphoma; Drug therapy; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose