Metabolic tumour volumes measured at staging in lymphoma: methodological evaluation on phantom experiments and patients

  • Michel Meignan
  • Myriam Sasanelli
  • René Olivier Casasnovas
  • Stefano Luminari
  • Federica Fioroni
  • Chiara Coriani
  • Helene Masset
  • Emmanuel Itti
  • Paolo G. Gobbi
  • Francesco Merli
  • Annibale Versari
Original Article



The presence of a bulky tumour at staging on CT is an independent prognostic factor in malignant lymphomas. However, its prognostic value is limited in diffuse disease. Total metabolic tumour volume (TMTV) determined on 18F-FDG PET/CT could give a better evaluation of the total tumour burden and may help patient stratification. Different methods of TMTV measurement established in phantoms simulating lymphoma tumours were investigated and validated in 40 patients with Hodgkin lymphoma and diffuse large B-cell lymphoma.


Data were processed by two nuclear medicine physicians in Reggio Emilia and Créteil. Nineteen phantoms filled with 18F-saline were scanned; these comprised spherical or irregular volumes from 0.5 to 650 cm3 with tumour-to-background ratios from 1.65 to 40. Volumes were measured with different SUVmax thresholds. In patients, TMTV was measured on PET at staging by two methods: volumes of individual lesions were measured using a fixed 41 % SUVmax threshold (TMTV41) and a variable visually adjusted SUVmax threshold (TMTVvar).


In phantoms, the 41 % threshold gave the best concordance between measured and actual volumes. Interobserver agreement was almost perfect. In patients, the agreement between the reviewers for TMTV41 measurement was substantial (ρ c = 0.986, CI 0.97 – 0.99) and the difference between the means was not significant (212 ± 218 cm3 for Créteil vs. 206 ± 219 cm3 for Reggio Emilia, P = 0.65). By contrast the agreement was poor for TMTVvar. There was a significant direct correlation between TMTV41 and normalized LDH (r = 0.652, CI 0.42 – 0.8, P <0.001). Higher disease stages and bulky tumour were associated with higher TMTV41, but high TMTV41 could be found in patients with stage 1/2 or nonbulky tumour.


Measurement of baseline TMTV in lymphoma using a fixed 41% SUVmax threshold is reproducible and correlates with the other parameters for tumour mass evaluation. It should be evaluated in prospective studies.


Metabolic volume Lymphoma Prognosis PET/CT 


Author contributions

Conception and design

Michel Meignan, Annibale Versari, Stefano Luminari, Francesco Merli, Paolo G. Gobbi, Olivier Casasnovas.

Collection and assembly of data

All authors.

Data analysis and interpretation

Myriam Sasanelli, Annibale Versari, Michel Meignan, Federica Fioroni, Chiara Coriani, Olivier Casasnovas, Emmanuel Itti.

Manuscript writing

Michel Meignan, Annibale Versari, Olivier Casasnovas.

Final approval of manuscript

All authors.

Conflicts of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Michel Meignan
    • 1
    • 10
  • Myriam Sasanelli
    • 1
  • René Olivier Casasnovas
    • 2
  • Stefano Luminari
    • 3
  • Federica Fioroni
    • 4
  • Chiara Coriani
    • 5
  • Helene Masset
    • 6
  • Emmanuel Itti
    • 1
  • Paolo G. Gobbi
    • 7
  • Francesco Merli
    • 8
  • Annibale Versari
    • 9
  1. 1.Department of Nuclear MedicineHôpital Henri Mondor and Paris-Est UniversityCréteilFrance
  2. 2.Department of HematologyCHU Le BocageDijonFrance
  3. 3.Department of Diagnostic, Clinic and Public Health MedicineUniversity of Modena and Reggio EmiliaModenaItaly
  4. 4.Department of Medical PhysicsSanta Maria Nuova Hospital-IRCCSReggio EmiliaItaly
  5. 5.Department of RadiologySanta Maria Nuova Hospital-IRCCSReggio EmiliaItaly
  6. 6.Department of RadiophysicsHenri Mondor HospitalCréteilFrance
  7. 7.Department of Internal Medicine and Gastroenterology, Fondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
  8. 8.Department of HematologySanta Maria Nuova Hospital-IRCCSReggio EmiliaItaly
  9. 9.Department of Nuclear MedicineSanta Maria Nuova Hospital-IRCCSReggio EmiliaItaly
  10. 10.Service de Médecine Nucléaire, EAC CNRS 7054, Hôpital Henri Mondor AP-HPParis-Est UniversityCréteilFrance

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