# Prognostic value of a simple distance index derived from PET maximum intensity projection

## TL;DR

This study introduces a new PET-based index, DmaxVoxMIP, which shows potential as a prognostic tool for diffuse large B-cell lymphoma patients.

## Contribution

The novel contribution is the introduction and evaluation of DmaxVoxMIP as a simpler and effective prognostic biomarker for DLBCL.

## Key findings

- DmaxVoxMIP values above a derived cutoff were associated with shorter survival in DLBCL patients.
- Combining DmaxVoxMIP with MTV identified three distinct risk groups for overall and progression-free survival.
- DmaxVoxMIP could potentially replace more complex dissemination indices in clinical practice.

## Abstract

Dissemination indices derived from [18F]FDG PET/CT, such as Dmax, Dmaxbulk, SPREADbulk, SPREADpatient, and DmaxVox are validated prognostic biomarkers in diffuse large B-cell lymphoma. We introduce DmaxVoxMIP, the distance between the outermost voxels of the two most distant lesions on a 2D maximum intensity projection image, which is easy and straightforward to obtain. Our goal is to evaluate DmaxVoxMIP’s prognostic value compared to other features for easier clinical application.

Metabolic tumor volume and dissemination indices were obtained from LIFEx, while DmaxVoxMIP was obtained from Telemis and OsiriX.

DmaxVoxMIP was not significantly higher in deceased than in living patients. However, patients with DmaxVoxMIP values above the derived cutoff showed a shorter survival. By combining MTV and DmaxVoxMIP, we obtained 3 risk groups for OS and PFS.

DmaxVoxMIP could advantageously replace other dissemination parameters as a prognostic index in patients with DLBCL.