Tumour necrosis as assessed with 18 F-FDG PET is a potential prognostic marker in diffuse large B cell lymphoma independent of MYC rearrangements

Xaver U. Kahle, Menno Hovingh, Walter Noordzij, Annika Seitz, Arjan Diepstra, Lydia Visser, Anke van den Berg, Tom van Meerten, Gerwin Huls, Ronald Boellaard, Thomas C. Kwee, Marcel Nijland

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Objectives: MYC gene rearrangements in diffuse large B cell lymphomas (DLBCLs) result in high proliferation rates and are associated with a poor prognosis. Strong proliferation is associated with high metabolic demand and tumour necrosis. The aim of this study was to investigate differences in the presence of necrosis and semiquantitative 18 F-FDG PET metrics between DLBCL cases with or without a MYC rearrangement. The prognostic impact of necrosis and semiquantitative 18 F-FDG PET parameters was investigated in an explorative survival analysis. Methods: Fluorescence in situ hybridisation analysis for MYC rearrangements, visual assesment, semiquantitative analysis of 18 F-FDG PET scans and patient survival analysis were performed in 61 DLBCL patients, treated at a single referral hospital between 2008 and 2015. Results: Of 61 tumours, 21 (34%) had a MYC rearrangement (MYC + ). MYC status was neither associated with the presence of necrosis on 18 F-FDG PET scans (necrosis PET ; p = 1.0) nor associated with the investigated semiquantitative parameters maximum standard uptake value (SUV max ; p = 0.43), single highest SUV max (p = 0.49), metabolic active tumour volume (MATV; p = 0.68) or total lesion glycolysis (TLG; p = 0.62). A multivariate patient survival analysis of the entire cohort showed necrosis PET as an independent prognostic marker for disease-specific survival (DSS) (HR = 13.9; 95% CI 3.0–65; p = 0.001). Conclusions: MYC rearrangements in DLBCL have no influence on the visual parameter necrosis PET or the semi-quantiative parameters SUV max , MATV and TLG. Irrespective of MYC rearrangements, necrosis PET is an independent, adverse prognostic factor for DSS. Key Points: • Retrospective analysis indicates that MYC rearrangement is not associated with necrosis on 18 F-FDG PET (necrosis PET ) scans or semiquantitative 18 F-FDG PET parameters. • Necrosis PET is a potential independent adverse prognostic factor for disease-specific survival in patients with DLBCL and is not influenced by the presence of MYC rearrangements.
Original languageEnglish
Pages (from-to)6018-6028
Number of pages11
JournalEuropean Radiology
Issue number11
Publication statusPublished - 1 Nov 2019
Externally publishedYes


  • Diffuse, large B cell, lymphoma
  • Fluorodeoxyglucose F18
  • MYC oncogene
  • Necrosis
  • Positron emission tomography

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