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Evaluation of diffuse large B-cell lymphoma patients with 64-slice multidetector computed tomography versus 18FDG positron emission tomography/computed tomography in initial staging and restaging after treatment
Evaluación de la estadificación inicial y la respuesta final al tratamiento de los pacientes con linfoma difuso de célula grande B con la tomografía computarizada de 64 detectores frente a la 18FDG tomografía por emisión de positrones/tomografía computarizada
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En el estudio inicial de TCMD64 se observó afectación extraganglionar con lesión de tejido blando paravertebral torácica izquierda (flecha en A), lesión sólida renal derecha (asterisco en B) y masa pélvica derecha con recubrimiento vascular (flecha en C) e infiltración de músculo piriforme (asterisco en C).</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Las imágenes D, E y F reflejan la desaparición de las masas paravertebral torácica, la tumoración renal, así como de la masa pélvica.</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">La paciente continúa en RC 3 años y 8 meses después.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nieves Gómez León, Gema Vega, Beatriz Rodríguez-Vigil Junco, Carlos Suevos Ballesteros" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Nieves" "apellidos" => "Gómez León" ] 1 => array:2 [ "nombre" => "Gema" "apellidos" => "Vega" ] 2 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Rodríguez-Vigil Junco" ] 3 => array:2 [ "nombre" => "Carlos" "apellidos" => "Suevos Ballesteros" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020618303292" "doi" => "10.1016/j.medcle.2018.08.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618303292?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775318302100?idApp=UINPBA00004N" "url" => "/00257753/0000015100000007/v1_201809210709/S0025775318302100/v1_201809210709/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020618303309" "issn" => "23870206" "doi" => "10.1016/j.medcle.2018.08.004" "estado" => "S300" "fechaPublicacion" => "2018-10-12" "aid" => "4476" "copyright" => "Elsevier España, S.L.U." 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Hospital Universitario de Álava, Vitoria, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de la estadificación inicial y la respuesta final al tratamiento de los pacientes con linfoma difuso de célula grande B con la tomografía computarizada de 64 detectores frente a la <span class="elsevierStyleSup">18</span>FDG tomografía por emisión de positrones/tomografía computarizada" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3483 "Ancho" => 2923 "Tamanyo" => 630021 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flow diagram.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Lymphomas constitute a heterogeneous group of malignant neoplasms of different behaviour and response to treatment, being approximately 5–6% of all malignant tumours and the fifth cause of cancer in the United States.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a> 85% of non-Hodgkin lymphomas (NHL) diagnosed in the adult come from the mature B lymphocyte. The latest review of the classification of lymphomas of the World Health Organization (WHO) groups NHL in two categories, stem cell neoplasms and mature cell neoplasms.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2,3</span></a> The most common subtype of NHL is diffuse large B-cell lymphoma (DLBCL), which constitutes approximately 1 in 3 lymphomas.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The staging or extension study is based on clinical and laboratory findings, imaging techniques and bone marrow biopsy (BMB). Until a few years ago, computed tomography (CT) was the diagnostic technique of choice, both for initial staging and for restaging at the end of treatment and for follow-up. However, CT has limitations in the detection of neoplastic infiltration of ganglia, organs of normal size and in certain anatomical locations, such as the bone marrow. In addition, it is not able to differentiate benign reactive changes from cancer involvement.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">On the other hand, positron emission tomography (PET) uses the introduction into the human body of molecules labelled with positron-emitting radioactive isotopes. PET with 18-fluoro-2-fluoro-2-deoxy-<span class="elsevierStyleSmallCaps">d</span>-glucose (<span class="elsevierStyleSup">18</span>F-FDG) as a metabolic tracer provides important functional information when detecting metabolic changes in the cellular use of glucose, making possible the early determination of pathological changes when the disease does not yet present structural alterations. This technique provides limited anatomical information due to the lack of <span class="elsevierStyleSup">18</span>F-FDG uptake specificity, also increased in certain inflammatory processes,<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a> and by the variable radiotracer affinity for the different histological types.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Among the histological subtypes of lymphoma that show an avidity for <span class="elsevierStyleSup">18</span>F-FDG in the literature, we find precisely the most prevalent types in the population: Hodgkin's disease, DLBCL and follicular lymphoma. The combined <span class="elsevierStyleSup">18</span>F-FDG PET/CT technique solves, in part, these limitations, allowing to obtain anatomical and functional information in a single merged image, improves the accuracy in the location of the lesions and allows greater certainty in their identification and characterization.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Most of the studies published in relation to the initial staging of lymphomas are retrospective and include very heterogeneous populations.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Even today there are no studies comparing the diagnostic accuracy of the <span class="elsevierStyleSup">18</span>F-FDG PET/CT and 64-slice multidetector CT (64MDCT) in the staging of lymphomas. In recent literature, studies comparing both techniques are referred to a 4-slice CT<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">7–10</span></a> or CT in which the number of detectors is not specified.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> However, the new CTs with an increasing number of detectors, which are progressively replacing the classical ones in our environment, allow a higher spatial resolution, of the order of 0.5<span class="elsevierStyleHsp" style=""></span>mm for 64MDCT, as well as a substantial reduction in the time of completion of a whole-body study, which is approximately 25<span class="elsevierStyleHsp" style=""></span>s, with smaller artefacts per movement. These technical advances contribute to a better differentiation between <span class="elsevierStyleItalic">bulky</span> masses and independent lymph nodes, greater accuracy in the measurement of ganglion diameters and their differentiation of bowel loops and more precise information on vascular involvement than the <span class="elsevierStyleSup">18</span>F-FDG PET/CT.</p><p id="par0035" class="elsevierStylePara elsevierViewall">New recommendations for the use of <span class="elsevierStyleSup">18</span>F-FDG PET/CT in the staging and response to the treatment of lymphomas have been presented at the 12th International Congress of Lymphomas. They have included, in the new classification of Lugano, the use of <span class="elsevierStyleSup">18</span>F-FDG PET/CT and a consensus has been reached for its use in the staging and monitoring of lymphomas with avidity for <span class="elsevierStyleSup">18</span>F-FDG, leaving CT for lymphomas without affinity for <span class="elsevierStyleSup">18</span>F-FDG.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">12,13</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The objective of this prospective study is to determine the concordance of the <span class="elsevierStyleSup">18</span>F-FDG PET/CT and 64MDCT with the reference standard both in the initial staging and in the evaluation of the final response to treatment in patients with DLBCL expressed in terms of partial response (PR), complete response (CR) and disease progression (DP).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0045" class="elsevierStylePara elsevierViewall">Multicenter clinical trial of 72 patients with DLBCL, in which the diagnostic imaging test was randomized at the beginning and at 6 months of treatment: <span class="elsevierStyleSup">18</span>FDG PET/CT (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>36) or 64MDCT (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>36). Patients were recruited in 5 university hospitals of the Autonomous Community of Madrid (La Princesa, La Paz, Fundación Jiménez Díaz, Rey Juan Carlos I and Clínica San Carlos) between January 2012 and June 2015, with an average follow-up after finishing treatment of 16.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.5 months (median of 14 months, range 1–36 months).</p><p id="par0050" class="elsevierStylePara elsevierViewall">The cases reported here represent a subgroup of patients from a previous study already published<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> with unique characteristics, making a specific analysis of it necessary.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The Clinical Research Ethics Committee of each participating centre approved the study and all subjects signed their written consent.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0060" class="elsevierStylePara elsevierViewall">Adult patients over 18 years of age with a histological diagnosis of DLBCL who had not been previously treated for lymphoma and without any prior imaging of staging were included. Patients with any of the following characteristics were excluded: chronic renal failure, human immunodeficiency virus infection, granulomatous or inflammatory disease, life expectancy of less than 3 months, allergy to iodinated contrasts, positive pregnancy test or suspicion or confirmation of substance abuse.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Each patient was treated according to their initial stage in each participating centre. Patients undergoing clinical trials were excluded.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Reference standard</span><p id="par0070" class="elsevierStylePara elsevierViewall">The reference standard<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">8–10</span></a> refers to the clinical stage according to the Ann Arbour classification depending on the sum of several components: clinical history, physical examination, laboratory data, iliac crest BMB, additional imaging tests if necessary, as well as lumbar puncture, endoscopy, biopsies and surgery in case of clinical indication. In addition, all discrepancies between the <span class="elsevierStyleSup">18</span>FDG PET/CT and 64MDCT and the reference standard were evaluated at the end of the treatment and during the follow-up to evaluate a possible modification of the lesion indicating, retrospectively, whether said lesions were due to lymphoma infiltration or not (confirmation by follow-up).</p><p id="par0075" class="elsevierStylePara elsevierViewall">The following variables were collected for all the patients: sociodemographic (sex, age, weight and general condition according to the <span class="elsevierStyleItalic">Eastern Cooperative Oncology Group</span>), clinical (initial staging according to the Ann Arbour classification modified by Cotswold, International Prognostic Index [IPI], B symptoms and lymph node and extranodal involvement), laboratory (albumin, haemoglobin, β<span class="elsevierStyleInf">2</span> microglobulin, lactate dehydrogenase, leukocytes, lymphocytes, BMB) and outcome (response at the end of treatment). The imaging studies were performed prospectively according to the assigned group using routine clinical practice protocols.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">64-Slice multidetector computed tomography</span><p id="par0080" class="elsevierStylePara elsevierViewall">All patients were studied using 64-slice multidetector Siemens or General Electric equipment.</p><p id="par0085" class="elsevierStylePara elsevierViewall">After the administration of intravenous iodinated contrast, a thoracic CT was performed in deep inspiration in the arterial phase followed by an abdominal CT in portal phase from the hepatic dome to the thighs, and finally a neck CT, from the base of the skull to the supraclavicular region.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The interpretation of the images was performed in each of the hospitals by a radiologist with experience in 64MDCT, different from those in charge of PET/CT studies. In case of discordance in any of the lesions, another radiologist made a second reading and a consensus was reached.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Lymph nodes with a short diameter greater than 10<span class="elsevierStyleHsp" style=""></span>mm were considered positive for lymphoma involvement, except in the inguinal region, where the limit was set at 15<span class="elsevierStyleHsp" style=""></span>mm.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Regarding extranodal involvement, an increase in the size of the organ, the anomalous enhancement of solid organs, the presence of soft tissue nodules or masses and both lytic and sclerotic bone lesions were considered positive.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Response Evaluation Criteria In Solid Tumours</span> were used as a method to evaluate the response to treatment.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Positron emission tomography/computed tomography with 18-fluorodeoxyglucose</span><p id="par0110" class="elsevierStylePara elsevierViewall">The patients were studied through a 6-slice detection CT scan (Biograph 6 True Point, Siemens and Biograph 16, Siemens) with a theoretical spatial resolution of 3–4<span class="elsevierStyleHsp" style=""></span>mm.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The studies were analyzed in each of the hospitals by a nuclear medicine specialist and a radiologist, both with experience in the field, using the same work station (Syngo™ software system, Siemens Medical Imaging). Both readings were performed independently with subsequent consensus and discussion of the discrepancies. The independent reading of the CT component of the PET/CT in our study was not considered necessary, since the combined technique has been validated for over a decade.</p><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">18</span>FDG PET/CT protocols for the study of tumours of the European Association of Nuclear Medicine, versions 1.0 and 2.0<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">15,16</span></a> were followed.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Each anatomical region susceptible of having lymphoma involvement was analyzed according to the metabolic information provided by PET. A semi-quantitative analysis was also included, following the 5-point scale of the Deauville criteria, as specified in our previous study.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The PERCIST criteria (1.0) were applied for the monitoring of the response after a previous lymphoma study by Tadashi et al. using the PERCIST criteria.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> These criteria evaluate the response to treatment according to the rate of change measured in SUL peak (<span class="elsevierStyleItalic">SUV Lean Body Mass Corrected</span>) in the most active lesion (target lesion) between the <span class="elsevierStyleSup">18</span>FDG PET/CT pre- and post-treatment studies. The SUL peak is defined as the highest mean value found in a spherical region (VOI, volume <span class="elsevierStyleItalic">of interest</span>) within a lesion.</p><p id="par0135" class="elsevierStylePara elsevierViewall">SUV has been one of the most used quantification parameters for the determination of tumour malignancy and evaluates the uptake of <span class="elsevierStyleSup">18</span>FDG in a certain area. However, there are multiple factors that can affect its value, among which the anthropometric variables of the patient stand out.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a> For this reason, the SUL parameter is used, which is equivalent to the corrected SUV based on the patient's body mass.</p><p id="par0140" class="elsevierStylePara elsevierViewall">PETVCAR (PET Volume Computer Assisted Reading, GE) automatic detection software was used to stage and monitor the response, comparing pre- and post-treatment studies. This programme automatically calculates the response according to PERCIST criteria, introducing and adjusting the lesion and reference organ uptake threshold parameters and segmenting the lesions.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data collection</span><p id="par0145" class="elsevierStylePara elsevierViewall">To facilitate data collection, a computer platform was designed (<span class="elsevierStyleItalic">LymphomaPetCt</span>) subdivided into 3 independent clinical areas (haematology, radiology and nuclear medicine). Through personalized and restricted access to the professionals of each area, the investigators accessed the electronic case report form <span class="elsevierStyleItalic">on-line</span>. The participating haematologists were responsible for introducing haematological variables into the system and radiologists and nuclear physicians were responsible for entering the data obtained from the images of 64MDCT and <span class="elsevierStyleSup">18</span>FDG PET/CT, respectively. All the platform data were exported to a <span class="elsevierStyleItalic">Microsoft Excel</span> format.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0150" class="elsevierStylePara elsevierViewall">A descriptive analysis of the sample and comparability of the study groups was carried out. The degree of concordance was analyzed through Cohen's unweighted (<span class="elsevierStyleItalic">κ</span>) and weighted (<span class="elsevierStyleItalic">κ</span><span class="elsevierStyleInf">p</span>) kappa coefficient, as the case may be. The analysis of validity through sensitivity (Se), specificity (E) and predictive values (PPV and NPV) was performed as a global measure of the diagnostic accuracy for each of the imaging techniques. All statistical tests were considered bilateral, considering statistical significance p values <0.05. The population estimate was made using the 95% confidence intervals (95% CI). Microsoft Excel 2013, IBM SPSS Statistics version 24.0, EPIDAT version 4.2 and R 3.4 were used.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Characteristics of patients</span><p id="par0155" class="elsevierStylePara elsevierViewall">The flow diaphragm of the patients’ recruitment is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">72 patients were analyzed, 36 men and 36 women, with an average age of 52 and 49 years, respectively.</p><p id="par0165" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the results of the comparability analysis by groups, where a correct randomization is verified.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Initial staging</span><p id="par0170" class="elsevierStylePara elsevierViewall">64MDCT achieved a correct staging in the majority of cases with high Se and Sp (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The discrepancies observed were secondary to the lack of diagnostic accuracy when assessing extranodal involvement, especially bone marrow infiltration, where 64MDCT underdiagnosed stages <span class="elsevierStyleSmallCaps">IV</span> of the gold standard as stages <span class="elsevierStyleSmallCaps">I</span>–<span class="elsevierStyleSmallCaps">III</span>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">The distribution of the stages with the PET/CT showed a symmetry similar to that obtained with 64MDCT (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Four cases were overdiagnosed as stadiums <span class="elsevierStyleSmallCaps">IV</span>, considering as pathological physiological uptake of the Waldeyer's ring in 2 cases and 2 non-tumoral bone lesions, corresponding to fibrous dysplasia and rib fractures in subacute phase without showing fracture callus.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Good concordance of both diagnostic tests was observed with the reference standard in the initial staging: <span class="elsevierStyleSup">18</span>FDG PET/CT (weighted <span class="elsevierStyleItalic">κ</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.5; 95% CI: 0.2–0.9; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.002) and 64MDCT ((<span class="elsevierStyleItalic">κ</span><span class="elsevierStyleInf">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.6; 95% CI: 0.1–0.9; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.009).</p><p id="par0185" class="elsevierStylePara elsevierViewall">No significant differences were demonstrated in the initial staging between the 2 diagnostic techniques in relation to the reference standard.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Response at the end of the treatment</span><p id="par0190" class="elsevierStylePara elsevierViewall">Fifty-three subjects reached CR criteria (73.6%), 10 (13.9%) showed DP including a patient who died and 9 (12.5%) achieved PR. 100% of patients with low IPI obtained CR, while 62.8% of patients with high IPI obtained a CR at the end of treatment (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0195" class="elsevierStylePara elsevierViewall">The number of discordant cases in 64MDCT was considerable both in the PR group and in EP, with response at the end of the treatment generally undervalued (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). That is why the Se of 64MDCT was low at the time of monitoring this objective, since it detected residual masses attributed to the tumour, without tumour remnants persisting in its sinus (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0200" class="elsevierStylePara elsevierViewall">Compared to 64MDCT, PET/CT showed a higher Se in PR and DP, maintaining a high Sp. In this way, it was able to better monitor the final response of the treatment, observing a distribution of the discordant cases less asymmetric than that of 64MDCT group (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), especially in EP.</p><p id="par0205" class="elsevierStylePara elsevierViewall">Concordance of 64MDCT group with the gold standard showed a simple agreement of 86.43% and <span class="elsevierStyleItalic">κ</span><span class="elsevierStyleInf">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.4 (95% CI: 0.1–0.8; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01); while the degree of agreement of the group <span class="elsevierStyleSup">18</span>F-FDG PET/CT with the gold standard was 91.67% with <span class="elsevierStyleItalic">κ</span><span class="elsevierStyleInf">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.7 (95% CI: 0.4–0.9; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001).</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Follow-up</span><p id="par0210" class="elsevierStylePara elsevierViewall">The follow-up of the patients was completed at least 6 months after the end of the treatment. During this period, a patient assigned to 64MDCT group died and was unable to complete the outcome evaluation. In the subsequent follow-up, 14 other patients died. The causes of death were: 73.3% due to disease progression (11 patients) and 26.7% due to septic shock (4 patients). According to the IPI estimated at the start of the study, most deaths occurred within the high IPI group (86.7%). The calculation of the relative risk for each IPI group was rejected by nominal logistic regression, since the basic exposure (low IPI) obtained a null incidence of the event <span class="elsevierStyleItalic">death</span>.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Extranodal involvement and infiltration of the bone marrow in the initial staging</span><p id="par0215" class="elsevierStylePara elsevierViewall">In relation to extranodal involvement, both 64MDCT and <span class="elsevierStyleSup">18</span>F-FDG PET/CT obtained a similar simple agreement rate and <span class="elsevierStyleItalic">κ</span><span class="elsevierStyleInf">p</span> index compared to the reference standard (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>), finding no significant differences between them (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.95).</p><p id="par0220" class="elsevierStylePara elsevierViewall">With respect to the detection of BM infiltration in the initial staging, poor concordance and low values of Se were observed with 64MDCT, with PET/CT showing a better concordance (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). However, no index test achieved an excellent correlation compared with BMB. No statistically significant differences were found between the <span class="elsevierStyleItalic">κ</span> of both index tests for the detection of BM infiltration (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.45).</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><p id="par0225" class="elsevierStylePara elsevierViewall">In 2014, after several meetings during the 12th International Conference on Malignant Lymphoma, the use of <span class="elsevierStyleSup">18</span>FDG PET/CT in staging and response monitoring<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">12,13</span></a> was recommended in the group of lymphomas that show avidity for <span class="elsevierStyleSup">18</span>FDG, leaving CT as the diagnostic method of choice for lymphomas without avidity for <span class="elsevierStyleSup">18</span>FDG. However, it is well known that, in our environment, the latest generation of MDCTs have more availability, are faster and more accessible than the <span class="elsevierStyleSup">18</span>FDG PET/CT and show a series of technical improvements that result in a greater diagnostic accuracy compared to the old CT methods. Although endorsed by an internationally renowned working group, these recommendations are not supported by a comparative analysis between <span class="elsevierStyleSup">18</span>FDG PET/CT and current MDCT techniques, specifically 64MDCT, in order to confirm whether there are significant differences between the two in the staging and restaging of the most common lymphoma subtype, DLBCL, which is a lymphoma with <span class="elsevierStyleSup">18</span>FDG avidity.</p><p id="par0230" class="elsevierStylePara elsevierViewall">Because of our study, we found that both tests adequately classified patients in 72% of cases. In addition, a good concordance of both diagnostic techniques was observed with the reference standard, which coincides with the data previously reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">18,19</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">100% of the patients with DLBCL were correctly identified through 64MDCT as stage <span class="elsevierStyleSmallCaps">II</span>. In fact, most disagreements were observed within stage <span class="elsevierStyleSmallCaps">IV</span>. The errors shown for this technique were due to: (1) understaging due to failure to detect bone marrow involvement adequately and (2) overstaging due to the fact that osseous lesions which were actually not associated with lymphoma were considered tumour involvement.</p><p id="par0240" class="elsevierStylePara elsevierViewall">Our results are compatible with those of the literature, confirming the limitations of CT due to the false negative rate, mainly in the detection of bone marrow infiltration.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">9,11</span></a> The number of CT detectors was not specified in the prospective studies reviewed, except in the one previously published by our group, where a 4-slice CT scan was used.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">8–10</span></a> Therefore, our study also confirms the limitation of new generation CTs, specifically 64MDCT in the staging of advanced stages of DLBCL.</p><p id="par0245" class="elsevierStylePara elsevierViewall">In relation to the global extranodal involvement excluding the study of the bone marrow, we found no significant differences between the two tests. This could explain why both 64MDCT and <span class="elsevierStyleSup">18</span>F-FDG PET/CT can be equally valid in the initial staging of the disease. These results differ from the data collected in the literature, where <span class="elsevierStyleSup">18</span>F-FDG PET/CT shows greater sensitivity and specificity than CT with intravenous contrast in the study of extranodal involvement,<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a> probably because the number of CT detectors is not taken into account in the literature reviewed.</p><p id="par0250" class="elsevierStylePara elsevierViewall">64MDCT is limited in cases in which an extranodal organ has diffuse infiltration, but is morphologically normal in appearance, and, in these cases, <span class="elsevierStyleSup">18</span>F-FDG PET/CT detects involvement better, as described in the literature by Omur.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a> Even in cases of diffuse hepatic or splenic involvement, <span class="elsevierStyleSup">18</span>F-FDG PET/CT shows higher detection rates than CT.</p><p id="par0255" class="elsevierStylePara elsevierViewall">Based on the results obtained, we consider that any of the 2 diagnostic tests could be indicated for the initial staging of the DLBCL, depending on availability in each hospital centre.</p><p id="par0260" class="elsevierStylePara elsevierViewall">The results of 64MDCT show that this technique did not adequately monitor the response at the end of treatment. Most of the discrepancies observed with the gold standard can be explained because patients who achieved CR were erroneously considered as PR and DP. The tendency of this technique to underestimate the response was due to the existence of post-treatment changes erroneously interpreted as tumour remnants, which include the radiological detection of pathological size residual masses without signs of malignant infiltration, mainly when the initial lesion is a large lymphadenopathic cluster, as well as the persistence of visible bone lesions in 64MDCT. These findings have already been confirmed by other authors, as published by Gallamini et al.,<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a> which found residual masses in up to 2/3 of patients diagnosed with 64MDCT.</p><p id="par0265" class="elsevierStylePara elsevierViewall">In contrast, the results obtained in the <span class="elsevierStyleSup">18</span>F-FDG PET/CT group to monitor the response at the end of the treatment in relation to the reference standard were better. A 92% concordance with the gold standard was observed with a high <span class="elsevierStyleItalic">κ</span><span class="elsevierStyleInf">p</span> (0.7). In this situation, the combined technique is more useful, confirming the actual degree of treatment response thanks to its ability to detect metabolic activity. These findings agree with those obtained by Martelli et al.,<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a> as they demonstrate that, in patients with DLBCL, a negative <span class="elsevierStyleSup">18</span>F-FDG PET/CT study at the end of treatment excludes the presence of viable residual tumour with a high degree of safety. This would coincide with the NPV results calculated for this diagnostic technique in our patients in the cases of PR (72–98%) and DP (80–99%).</p><p id="par0270" class="elsevierStylePara elsevierViewall">The type of therapy applied should be known when evaluating these patients after treatment. The advent of new treatments such as immunotherapy, which can modify the behaviour of these tumours, implies the constant updating of the response criteria with both diagnostic techniques.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a></p><p id="par0275" class="elsevierStylePara elsevierViewall">On the other hand, <span class="elsevierStyleSup">18</span>F-FDG PET/CT has as limitation the glucose avidity of inflammatory processes in locations that can also be affected by lymphoma, such as Waldeyer's ring or lungs, which leads to a high rate of false positives. In these cases, it is important to carefully assess the findings of the CT component and the patient's symptoms, to determine whether the abnormalities correspond to lymphoma involvement.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a></p><p id="par0280" class="elsevierStylePara elsevierViewall">Lymphoma-associated BM infiltration implies disseminated disease and worsens the prognosis of patients with DLBCL.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> In the 64MDCT group we obtained data confirming the poor diagnostic accuracy in the detection of BM infiltration, while, despite obtaining sensitivity (67%) and specificity (81%) values for <span class="elsevierStyleSup">18</span>F-FDG PET/CT within the ranges of the literature,<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a> its diagnostic accuracy compared with that of BMB does not reach an excellent concordance, concluding in another study<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> that <span class="elsevierStyleSup">18</span>F-FDG PET/CT is more sensitive than CT in the detection of lymphoma involvement in multiple locations, although its accuracy in the detection of spinal infiltration is limited, so BMB could not be avoided.</p><p id="par0285" class="elsevierStylePara elsevierViewall">Other authors compare both index tests and conclude that PET/CT is superior to BMB in detecting the involvement of BM due to its high NPV,<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a> so a confirmation BMB might not be necessary in cases where <span class="elsevierStyleSup">18</span>F-FDG PET/CT did not detect involvement of BM at the end of the treatment. However, a meta-analysis<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a> published in 2014 concluded that in the evaluation of patients with DLBCL, <span class="elsevierStyleSup">18</span>F-FDG PET/CT and BMB are complementary diagnostic techniques in which the first can be used as a guide to perform the puncture in the most affected site.</p><p id="par0290" class="elsevierStylePara elsevierViewall">The nature of the disease studied and, as in other published studies, the imperfection of the gold standard due to the impossibility of verifying histologically all the possible abnormalities detected by the imaging methods, constitute an inherent limitation in the study carried out.</p><p id="par0295" class="elsevierStylePara elsevierViewall">In conclusion, our study shows a correct initial staging of patients with DLBCL compared to the reference standard with both imaging tests 64MDCT and <span class="elsevierStyleSup">18</span>FDG PET/CT, so they can be used interchangeably in our environment depending on the availability in each centre.</p><p id="par0300" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">18</span>FDG PET/CT is superior to 64MDCT in the evaluation of patients with lymphoma at the end of treatment according to the outcome expressed in terms of PR, CR and DP.</p><p id="par0305" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">18</span>FDG PET/CT is superior to 64MDCT in the detection of bone marrow infiltration. In our environment, <span class="elsevierStyleSup">18</span>FDG PET/CT should not replace BMB in the evaluation of patients with lymphoma, but it could be the technique of choice to guide the biopsy to the most affected site.</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Funding</span><p id="par0310" class="elsevierStylePara elsevierViewall">This work has been funded by a <span class="elsevierStyleGrantSponsor" id="gs1">Research Project of the Healthcare Research Fund</span><span class="elsevierStyleGrantNumber" refid="gs1">FIS 11/01800</span>. Registered as a WHO clinical trial in:</p><p id="par0315" class="elsevierStylePara elsevierViewall"><a id="intr0010" class="elsevierStyleInterRef" href="http://apps.who.int/">http://apps.who.int</a>/trialsearch/default.aspx</p><p id="par0320" class="elsevierStylePara elsevierViewall"><a id="intr0015" class="elsevierStyleInterRef" href="http://apps.who.int/">http://apps.who.int</a>/trialsearch/Trial2.aspx? TrialID=ISRCTN79508741</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflict of interests</span><p id="par0325" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1099620" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1040811" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1099621" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1040810" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Reference standard" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "64-Slice multidetector computed tomography" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Positron emission tomography/computed tomography with 18-fluorodeoxyglucose" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Data collection" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0045" "titulo" => "Results" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Characteristics of patients" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Initial staging" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Response at the end of the treatment" ] 3 => array:2 [ "identificador" => "sec0065" "titulo" => "Follow-up" ] 4 => array:2 [ "identificador" => "sec0070" "titulo" => "Extranodal involvement and infiltration of the bone marrow in the initial staging" ] ] ] 7 => array:2 [ "identificador" => "sec0075" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0080" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0085" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-10-10" "fechaAceptado" => "2018-03-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1040811" "palabras" => array:4 [ 0 => "FDG-PET/CT" 1 => "CT" 2 => "Lymphoma" 3 => "Non-Hodgkin's lymphoma" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1040810" "palabras" => array:4 [ 0 => "FDG-PET/TC" 1 => "TC" 2 => "Linfoma" 3 => "Linfoma no Hodgkin" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To prospectively compare the accuracy in initial staging and end-of-treatment restaging of diffuse large B-cell lymphoma (DLBCL) between 64-slice multidetector computed tomography (64MDCT) and 18FDG positron emission tomography/computed tomography (18FGD PET/CT) with intravenous contrast injection.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Randomized and blind controlled clinical multicentric trial that included biopsy-proven DLBCL patients. Seventy-two patients from five different hospitals in the region of Madrid, Spain, were enrolled in the study between January 2012 and June 2015. Thirty-six were randomly allocated to <span class="elsevierStyleSup">18</span>FDG PET/TC and the other 36–64MDCT for initial staging and end-of-treatment restaging. A nuclear medicine physician and a radiologist independently analyzed <span class="elsevierStyleSup">18</span>FDG PET/TC images and reached an agreement post hoc. 64MDCT images were separately evaluated by a different radiologist. Every set of images was compared to the reference standard that included clinical data, complementary tests and follow-up. The study was approved by participating centres’ ethics committees and written informed consent was obtained from all the participants.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A good agreement was observed between both diagnostic techniques and the reference standard in initial staging [<span class="elsevierStyleSup">18</span>FDG PET/CT (<span class="elsevierStyleItalic">k</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.5) and 64MDCT (<span class="elsevierStyleItalic">k</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.6)], although only the <span class="elsevierStyleSup">18</span>FDG PET/TC showed a good agreement with the reference standard for the end-of-treatment restaging (<span class="elsevierStyleItalic">k</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.7).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In DLBCL, both <span class="elsevierStyleSup">18</span>FDG PET/TC and 64MDCT have shown good agreement with the reference standard in initial staging. Nevertheless, <span class="elsevierStyleSup">18</span>FDG PET/CT has shown to be superior to 64MDCT in end-of-treatment response assessment.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Fundamento y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Comparar prospectivamente la exactitud diagnóstica de la tomografía computarizada de 64 detectores (TCMD64) y la tomografía por emisión de positrones/tomografía computarizada (<span class="elsevierStyleSup">18</span>FDG PET/TC) con contraste intravenoso en pacientes con linfoma difuso de células grandes B (LDCGB) en la estadificación inicial y en la evaluación de la respuesta al final del tratamiento.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Ensayo clínico controlado multicéntrico que incluyó 72 pacientes de 5 hospitales de la Comunidad de Madrid entre enero de 2012 y junio de 2015, aleatorizados de forma ciega a una diferente prueba de imagen inicial y final, 36 a <span class="elsevierStyleSup">18</span>FDG PET/TC y 36 a TCMD64. Un médico nuclear y un radiólogo interpretaron la <span class="elsevierStyleSup">18</span>FDG PET/TC de manera independiente, llegando a un consenso post hoc. Por otro lado, un radiólogo ajeno interpretó la TCMD64 por separado. El patrón de referencia incluyó datos clínicos, pruebas complementarias y seguimiento. El Comité Ético de cada hospital aprobó el estudio y los sujetos firmaron su consentimiento por escrito.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se observó buena concordancia de ambas pruebas diagnósticas con el patrón de referencia en la estadificación inicial (<span class="elsevierStyleSup">18</span>FDG PET/CT [k<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,5] y TCMD64 [k<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,6]), existiendo solo buena concordancia en la evaluación de la respuesta al final del tratamiento con la <span class="elsevierStyleSup">18</span>FDG PET/TC (k<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,7).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En la estadificación inicial de pacientes con LDCGB existe un grado de acuerdo satisfactorio de la <span class="elsevierStyleSup">18</span>FDG PET/TC y la TCMD64 con el patrón de referencia, mientras que en la evaluación de la respuesta al final del tratamiento la <span class="elsevierStyleSup">18</span>FDG PET/TC es superior a la TCMD64.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Please cite this article as: Gómez León N, Vega G, Rodríguez-Vigil Junco B, Suevos Ballesteros C. Evaluación de la estadificación inicial y la respuesta final al tratamiento de los pacientes con linfoma difuso de célula grande B con la tomografía computarizada de 64 detectores frente a la <span class="elsevierStyleSup">18</span>FDG tomografía por emisión de positrones/tomografía computarizada. Med Clin (Barc). 2018;151:255–264.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3483 "Ancho" => 2923 "Tamanyo" => 630021 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flow diagram.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2384 "Ancho" => 2000 "Tamanyo" => 550719 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">75-Year-old woman with stage <span class="elsevierStyleSmallCaps">IV</span> DLBCL. In the initial study of 64MDCT, extranodal involvement was observed with left thoracic paravertebral soft tissue lesion (arrow in A), solid right renal lesion (asterisk in B) and right pelvic mass with vascular covering (arrow in C) and piriformis muscle infiltration (asterisk in C).</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Images D, E and F show the disappearance of the thoracic paravertebral masses, the renal tumour, as well as the pelvic mass.</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The patient continues in CR 3 years and 8 months later.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3056 "Ancho" => 2000 "Tamanyo" => 469924 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">57-Year-old male with diagnosis of stage <span class="elsevierStyleSmallCaps">IV</span> DLBCL.</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">A. Initial PET/CT study (A–E). Infiltration of the right scapula (arrowhead), right axillary lymphadenopathy (arrow) and lymphadenopathic conglomerate in the porta hepatis (asterisk). PET (A–C) and CT imaging without merging are shown on the left of the image.</p> <p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">B. Response after treatment that shows complete disease remission. The patient continues in CR 3 years later.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Qualitative variables</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">64MDCT (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>36)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleSup">18</span>FDG PET/CT (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>36)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span></th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Male</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">60 years</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.62 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Symptoms B</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.63 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">ECOG</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">2</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.57 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">βHigh 2-microglobulin</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">High LDH</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Leukocytes</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">15,000</span>/<span class="elsevierStyleItalic">mm</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">3</span></span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Lymphocytes</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">600</span>/<span class="elsevierStyleItalic">mm</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">3</span></span><span class="elsevierStyleItalic">or</span> <<span class="elsevierStyleItalic">8</span>% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.95 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Extranodal involvement</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.63 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Bone marrow involvement</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Ann Arbour staging</span><span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">III</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.77 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Low IPI</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low intermediate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>High intermediate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1880609.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Quantitative variables</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">64MDCT</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleSup">18</span>FDG PET/CT</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black"></th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Size (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">160 (22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">167 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haemoglobin (g/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (2.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Albumin (g/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.6 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.93 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1880606.png" ] ] ] "notaPie" => array:5 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Fever, night sweats and weight loss above 10% in the previous 6 months.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Ambulatory and able to take care of himself, but unable to perform any work.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Plasma normal value is 1.06–2.22<span class="elsevierStyleHsp" style=""></span>mg/l.</p>" ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">The normal value of LDH is less than 450<span class="elsevierStyleHsp" style=""></span>U/l with variations according to the reference laboratory (200–450)<span class="elsevierStyleHsp" style=""></span>U/l according to Wrobleski or 60–100<span class="elsevierStyleHsp" style=""></span>U/l according to Wacker).</p>" ] 4 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "e" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">The calculation of the international prognostic index (IPI) for DLBCL was made according to the following variables: age >60 years (1 point), III or IV Ann Arbour staging (1 point), 2 or more extranodal sites affected (1 point), high LDH (1 point), ECOG<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>2 (1 point). Four risk groups were defined according to the score obtained: low risk (score<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0), intermediate-low risk (score<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1), intermediate-high risk (score<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) and high risk (score 3).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Comparability between groups.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">NPV: negative predictive value; PPV: positive predictive value.</p>" "tablatextoimagen" => array:4 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="11" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Initial staging with 64MDCT compared to the reference standard</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Ann Arbour staging. Reference standard</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensitivity<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Specificity<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PPV<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NPV<br>(95% CI)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">I \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">II \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">III \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="5" align="left" valign="top">Ann Arbour staging<br>64MDCT</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (12–88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 (83–99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (20–99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91 (75–98) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 (40–100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97 (84–100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 (29–99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 (74–98) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 (9–99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88 (72–97) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (43–78) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 (82–99) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 (52–90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 (36–91) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81 (58–95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 (32–84) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1880605.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="11" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Initial staging with <span class="elsevierStyleSup">18</span>FDG PET/CT compared with the reference standard</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Ann Arbour staging. Reference standard</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensitivity<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Specificity<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PPV<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NPV<br>(95% CI)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">I \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">II \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">III \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="5" align="left" valign="top">Ann Arbour staging<br><span class="elsevierStyleSup">18</span>FDG PET/CT</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 (15–95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83 (66–95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (12–88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93 (78–99) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 (30–96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 (82–99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83 (36–99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93 (78–99) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (7–93) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86 (70–95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (7–93) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94 (80–99) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 (56–94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (48–93) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 (56–94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (48–93) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1880612.png" ] ] 2 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="10" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Response at the end of treatment with 64MDCT compared to the reference standard</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">RECIST Reference standard</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensitivity<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Specificity<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PPV<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NPV<br>(95% CI)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DP \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="left" valign="top">RECIST<br>64MDCT</td><td class="td" title="table-entry " align="left" valign="top">Complete \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82 (63–94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 (30–96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95 (74–99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (19–81) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Partial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (0.8–90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84 (67–95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (0.4–64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93 (77–99) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Progression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (0.6–80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 (74–98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (0.6–80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 (74–98) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1880607.png" ] ] 3 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="10" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Response at the end of treatment with the <span class="elsevierStyleSup">18</span>F-FDG PET/CT compared to the reference standard</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">RECIST Reference standard</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensitivity<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Specificity<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PV<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NPV<br>(95% CI)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DP \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="left" valign="top">PERCIST<br><span class="elsevierStyleSup">18</span>F-FDG/CT</td><td class="td" title="table-entry " align="left" valign="top">Complete \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84 (64–95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 (40–94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86 (67–97) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 (35–90) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Partial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (12–88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83 (65–94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (8–76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 (72–98) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Progression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 (15–95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97 (83–99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (20–99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94 (80–99) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1880604.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Results in the initial staging and final response with 64MDCT and <span class="elsevierStyleSup">18</span>FDG PET/CT compared with the reference standard.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">NPV: negative predictive value; PPV: positive predictive value.</p>" "tablatextoimagen" => array:4 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="9" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Extranodal involvement<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">a</span></a></th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Reference standard</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensitivity<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Specificity<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PPV<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NPV<br>(95% CI)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">64MDCT</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">82 (66–98)</td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">71 (48–95)</td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">82 (66–98)</td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">71 (48–95)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1880610.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Reference standard</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensitivity<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Specificity<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PPV<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NPV<br>(95% CI)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top"><span class="elsevierStyleSup">18</span>F-FDG-PET/CT</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">85 (69–100)</td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">69 (46–91)</td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">77 (60–95)</td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">79 (57–100)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1880603.png" ] ] 2 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="9" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Bone marrow involvement<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">b</span></a></th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Reference standard</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensitivity<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Specificity<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PPV<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NPV<br>(95% CI)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">64MDCT</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">17 (0–64)</td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">100 (88–100)</td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">100 (2.5–100)</td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">86 (70–95)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1880611.png" ] ] 3 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Reference standard</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Se<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sp<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PPV<br>(95% CI)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NPV<br>(95% CI)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top"><span class="elsevierStyleSup">18</span>F-FDG-PET/CT</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">67 (30–93)</td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">81 (62–94)</td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">55 (23–83)</td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">88 (69–97)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1880608.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Extranodal involvement results of both index tests compared with the reference standard. Simple agreement of 78% and 0.53 of <span class="elsevierStyleItalic">κ</span><span class="elsevierStyleInf">p</span> index (95% CI: 0.25–0.81; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01) in the 64TCMD group. <span class="elsevierStyleItalic">In the</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">18</span></span><span class="elsevierStyleItalic">F-FDG PET/CT</span> group, the simple agreement rate was 78%, with a <span class="elsevierStyleItalic">κ</span><span class="elsevierStyleInf">p</span> index of 0.54 (95% CI: 0.27–0.82; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001).</p>" ] 1 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Bone marrow involvement results of both index tests compared with the reference standard. <span class="elsevierStyleItalic">In the 64MDCT</span> group there was an 86% simple agreement and a <span class="elsevierStyleItalic">κ</span><span class="elsevierStyleInf">p</span> of 0.2 (95% CI: 0.15–0.65; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02). <span class="elsevierStyleItalic">In the</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">18</span></span><span class="elsevierStyleItalic">F-FDG PET/CT</span> group there was a 78% simple agreement with an <span class="elsevierStyleItalic">κ</span><span class="elsevierStyleInf">p</span> index of 0.5 (95% CI: 0.13–0.77; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.006).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Results of extranodal and bone marrow involvement with 64MDCT and <span class="elsevierStyleSup">18</span>FDG PET/CT compared with the reference standard.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0150" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Epub 27.05.09]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cancer statistics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. 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