18F-FDG PET/CT metabolic network connectivity in clinical staging of diffuse large B-cell lymphoma.

INTRODUCTION: Diffuse large B-cell lymphoma (DLBCL) is the most common and highly heterogeneous subtype of non-Hodgkin lymphoma, and accurate staging is essential for treatment planning and prognosis. This study explored the value of 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) metabolic network connectivity for the clinical staging of DLBCL. METHODS: Forty-two previously untreated patients (23 males, 19 females; aged 30-82 years) diagnosed as de novo DLBCL, not otherwise specified, were retrospectively analyzed (stage I, n=3; II, n=5; III, n=9; IV, n=25). Lesions were automatically delineated using a 41% SUVmax threshold. Four metabolic and four diffusion parameters were computed, and a radiomics-based lesion metabolic network was constructed for each patient with stage II-IV disease. RESULTS: The degree Pearson correlation coefficient (DPCC) of the metabolic network differed significantly among stages II-IV (n=39, p<0.001) and between stage II (n=5) and stages III+IV (n=34) (p<0.001), whereas conventional metabolic, diffusion, and other network parameters showed no significant differences. DPCC decreased with increasing stage, indicating rising inter-lesion metabolic heterogeneity. DISCUSSION: The DPCC of 18F-FDG PET/CT metabolic network connectivity is associated with clinical stage in DLBCL patients with multiple measurable lesions and may provide complementary network-level information. These exploratory findings require external validation in larger, multicenter cohorts.