Pre-Treatment 18F-FDG PET/CT reveals altered brain metabolic network connectivity in patients with diffuse large B-cell lymphoma: Implications for cancer-related cognitive impairment

Background

Cancer-related cognitive impairment (CRCI) is prevalent among patients with diffuse large B-cell lymphoma (DLBCL), often manifesting prior to treatment and frequently remaining unrecognized.

Purpose

This study aims to assess CRCI in DLBCL patients before treatment by utilizing 18F-FDG PET/CT metabolic networks to facilitate early detection and intervention.

Methods

We conducted a cross-sectional study involving 77 participants from our hospital’s PET-CT center, which included 15 healthy controls and 62 DLBCL patients (29 in stages I + II and 33 in stages III + IV). Using the automated anatomical atlas 3 (AAL3) template, we segmented the 18F-FDG PET brain images into 90 regions, extracted the standard uptake value (SUV) for each region, and calculated its ratio (SUVr) using the cerebellum as a reference. We analyzed connectivity within the brain’s metabolic network across the three groups.

Results

DLBCL patients exhibited significantly lower mean degree, closeness centrality, degree of participation in connected components (DPCC), average clustering coefficient (ACC), and clustering coefficient compared to controls (P < 0.001). Patients in stages III + IV demonstrated even lower values. The average shortest path length (ASPL) was significantly higher in DLBCL patients, with stage III + IV patients showing an ASPL nearly three times that of controls and twice that of stage I + II patients. Significant differences in mean degree, closeness centrality, and clustering coefficient were observed among the groups (P < 0.001).

Conclusions

CRCI is apparent in DLBCL patients at early stages and deteriorates with disease progression. It is crucial to integrate early detection and cognitive assessments into clinical practice for DLBCL patients.