E5264. Artificial Intelligence-Generated Delta SUVmax and MTV Improves Clinical Decisions on Interim/Completion PET in Patients With Lymphoma
  1. Arushi Virmani; RUSH University Medical Center
  2. Pokhraj Suthar; RUSH University Medical Center
  3. Parameswaran Venugopal; RUSH University Medical Center
PET/CT is a widely utilized noninvasive imaging modality to assess response to various treatment regimens in patients with Hodgkin's and certain non-Hodgkin's lymphoma. Response assessment on interim PET/CT (i-PET), usually performed after two cycles of chemotherapy, or a completion PET/CT performed after six cycles of chemotherapy, is helpful in assessing metabolic response to therapy. Response assessment is based on Deauville scoring, where any residual FDG uptake greater than that of the liver (Deauville score of 4 or 5) is considered an unfavorable response. In our experience at a tertiary care teaching institution, there have been a few subsets of patients with significant or marked response on i-PET/CT or completion PET/CT who ended up with Deauville score of 4 (based on the current reporting guidelines). This subset of patients usually required a discussion with the treating physician, highlighting marked reduction in interval metabolic activity (SUVmax) and interval metabolic tumor volume (delta MTV). Most of these cases either continue with the winning treatment (after i-PET/CT) or do a short-term follow-up without any intervention (after completion PET/CT). We present a case-based pictorial review highlighting the importance of an artificial intelligence (AI)-generated delta SUVmax and delta MTV that improved the confidence in clinical decision making on interim and/or completion FDG PET/CT scans in patients with lymphoma with a Deauville score of 4.

Educational Goals / Teaching Points
We present interesting cases with follow-up to completion chemotherapy and/or subsequent imaging follow-up to highlight the importance of reporting delta SUVmax and delta MTV, especially in a subset of patients with Deauville score of 4.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This case-based pictorial review focuses on highlighting the importance of reporting delta SUVmax and delta MTV of the residual lesion in a subset of patients with Deauville score of 4. Providing this additional information helps the clinician in specific clinical situations improve treatment optimization.

Adding AI-generated delta SUVmax and delta MTV, especially in a subset of patients with Deauville score of 4, impacts patient management and helps the clinician improve treatment optimization, with most cases continuing the winning treatment or ending with close follow-up.