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Prognostic Value of Pretreatment Radiomic Features of 18F-FDG PET in Patients With Hodgkin Lymphoma

Lue, Kun-Han MSc*,†; Wu, Yi-Feng MD, MSc; Liu, Shu-Hsin MD*,§; Hsieh, Tsung-Cheng PhD; Chuang, Keh-Shih PhD; Lin, Hsin-Hon PhD†,¶,**; Chen, Yu-Hung MD*

doi: 10.1097/RLU.0000000000002732
Original Articles

Purpose This study investigated whether a radiomic analysis of pretreatment 18F-FDG PET can predict prognosis in patients with Hodgkin lymphoma (HL).

Methods Forty-two patients who were diagnosed as having HL and underwent pretreatment 18F-FDG PET scans were retrospectively enrolled. For each patient, we extracted 450 radiomic features from PET images. The prognostic significance of the clinical and radiomic features was assessed in relation to progression-free survival (PFS) and overall survival (OS). Receiver operating characteristic curve, Cox proportional hazards regression, and Kaplan-Meier analyses were performed to examine the potential independent predictors and to evaluate the predictive value.

Results Intensity nonuniformity extracted from a gray-level run-length matrix and the Ann Arbor stage were independently associated with PFS (hazard ratio [HR] = 22.8, P < 0.001; HR = 7.6, P = 0.024) and OS (HR = 14.5, P = 0.012; HR = 8.5, P = 0.048), respectively. In addition, SUV kurtosis was an independent prognosticator for PFS (HR = 6.6, P = 0.026). We devised a prognostic scoring system based on these 3 risk predictors. The proposed scoring system further improved the risk stratification of the current staging classification (P < 0.001).

Conclusions The radiomic feature intensity nonuniformity is an independent prognostic predictor of PFS and OS in patients with HL. We devised a prognostic scoring system, which may be more beneficial for patient risk stratification in guiding therapy compared with the current Ann Arbor staging system.

From the *Department of Nuclear Medicine, Buddhist Tzu Chi General Hospital, Hualien

Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu

Department of Hematology and Oncology, Buddhist Tzu Chi General Hospital

§Department of Medical Imaging and Radiological Sciences, Tzu Chi University of Science and Technology

Institute of Medical Sciences, Tzu-Chi University, Hualien

Department of Radiation Oncology, Chang Gung Memorial Hospital

**Medical Physics Research Center, Institute for Radiological Research, Chang Gung University/Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Received for publication March 25, 2019; revision accepted June 2, 2019.

Conflicts of interest and sources of funding: none declared.

Correspondence to: Hsin-Hon Lin, PhD, Medical Physics Research Center, Institute for Radiological Research, Chang Gung University/Chang Gung Memorial Hospital, No. 259, Wenhua 1st Rd, Guishan Dist, Taoyuan 33302, Taiwan. E-mail:; or Yu-Hung Chen, MD, Department of Nuclear Medicine, Buddhist Tzu Chi General Hospital, No. 707, Sec 3, Chung-Yang Rd, Hualien 97002, Taiwan. E-mail:

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Online date: July 15, 2019

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