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At present,  18 F-fluorodesoxyglucose ( 18 FDG) positron emission tomography (PET)/computed tomography (CT) cannot be used to omit a bone marrow biopsy (BMB) among initial staging procedures in follicular lymphoma (FL). The additional diagnostic value of skeletal textural features on baseline  18 FDG-PET/CT in diffuse large B-cell lymphoma (DLBCL) patients has given promising results. The aim of this study is to evaluate the value of  18 FDG-PET/CT radiomics for the diagnosis of bone marrow involvement (BMI) in FL patients. This retrospective bicentric study enrolled newly diagnosed FL patients addressed for baseline  18 FDG PET/CT. For visual assessment, examinations were considered positive in cases of obvious bone focal uptakes. For textural analysis, the skeleton volumes of interest (VOIs) were automatically extracted from segmented CT images and analysed using LifeX software. BMB and visual assessment were taken as the gold standard: BMB −/PET − patients were considered as bone- NEGATIVE  patients, whereas BMB +/PET −, BMB −/PET + and BMB +/PET + patients were considered bone- POSITIVE  patients. A LASSO regression algorithm was used to select features of interest and to build a prediction model. Sixty-six consecutive patients were included: 36 bone- NEGATIVE  (54.5%) and 30 bone- POSITIVE  (45.5%). The LASSO regression found variance _GLCM , correlation _GLCM , joint entropy _GLCM  and busyness _NGLDM  to have nonzero regression coefficients. Based on ROC analysis, a cut-off equal to − 0.190 was found to be optimal for the diagnosis of BMI using PET pred.score. The corresponding sensitivity, specificity, PPV and NPV values were equal to 70.0%, 83.3%, 77.8% and 76.9%, respectively. When comparing the ROC AUCs with using BMB alone, visual PET assessment or PET pred.score, a significant difference was found between BMB versus visual PET assessments ( p  = 0.010) but not between BMB and PET pred.score assessments ( p  = 0.097). Skeleton texture analysis is worth exploring to improve the performance of  18 FDG-PET/CT for the diagnosis of BMI at baseline in FL patients.

Diagnostic value of baseline 18FDG PET/CT skeletal textural features in follicular lymphoma