PET scan image illustrating lymphoma treatment assessment with the Deauville score.

Deauville Score & Lymphoma: What You Need to Know About Liver Uptake

Lena Kashyap in Health & Wellness June 2025 • 4 min read.

"Understand the nuances of Deauville scoring in lymphoma treatment, particularly how liver steatosis and glucose levels can impact PET scan results."

In the realm of lymphoma treatment, the Deauville score (DS) stands as a crucial tool for assessing how well a patient is responding to therapy. This scoring system, primarily reliant on PET scans, helps oncologists determine the effectiveness of treatment by evaluating the uptake of a radioactive glucose analog (FDG) in lymphoma lesions compared to a reference organ, often the liver.

However, the accuracy of Deauville scoring can be influenced by various factors, including the presence of liver steatosis (fatty liver disease) and fluctuations in blood glucose levels. Recently, experts like Peters et al. have raised important questions about the reliability of using the liver as a reference organ, particularly when steatosis is present.

This article dives into these concerns, offering a comprehensive look at how medical professionals navigate these challenges to ensure the most accurate assessment and treatment strategies for lymphoma patients. We'll explore the debates, the science, and what these considerations mean for your understanding of cancer care.

Deauville Score (DS): Why Liver Uptake Matters?

PET scan image illustrating lymphoma treatment assessment with the Deauville score.

The Deauville score, a cornerstone in evaluating treatment response in lymphoma, hinges on comparing the metabolic activity of lymphoma lesions against a reference point. Typically, the liver steps in as that benchmark. The score, derived from PET scan imaging, reflects how actively cancer cells are uptaking FDG, a glucose analog. A lower score generally indicates a positive response to treatment, while a higher score may signal the need for adjustments.

Medical guidelines often lean towards using standardized uptake values (SUL) rather than SUV. Here's why:

Standardized Uptake Value (SUV): A basic measure of FDG concentration in a specific area, normalized to body weight or injected dose. It's simple but can be affected by patient size and scanner variations.
Standardized Uptake Value Lean (SUL): Refines SUV by normalizing FDG uptake to lean body mass, providing a more accurate comparison across different body compositions.

Both SULmax and SUVmax provide similar information in most clinical settings. However, recent discussions have highlighted factors like liver steatosis and blood glucose levels, which could potentially skew the reliability of liver uptake as a consistent reference.

Navigating the Nuances: Ensuring Accurate Deauville Scoring

The journey through lymphoma treatment is complex, and accurate assessment is paramount. While factors like liver steatosis and glucose levels can introduce variability, medical professionals are well-equipped to address these challenges. By adhering to established guidelines, carefully monitoring blood glucose, and utilizing advanced imaging techniques, oncologists strive to ensure the Deauville score remains a reliable tool in guiding treatment decisions and optimizing patient outcomes. Open communication with your healthcare team is key, ensuring you're informed and confident in every step of your care.

Everything You Need To Know

What is the Deauville score (DS) and why is it important in lymphoma treatment?

The Deauville score (DS) is a critical tool used in lymphoma treatment to assess how well a patient is responding to therapy. It's primarily based on PET scans, which evaluate the uptake of a radioactive glucose analog, FDG, in lymphoma lesions. The DS compares the metabolic activity of these lesions to a reference organ, often the liver. A lower Deauville score generally indicates a positive response to treatment, while a higher score may suggest the need for adjustments to the treatment plan. This scoring system is essential for oncologists to make informed decisions about the effectiveness of the treatment and to adjust treatment strategies accordingly.

How does liver steatosis affect the accuracy of the Deauville score (DS) and why is this a concern?

Liver steatosis, or fatty liver disease, can potentially influence the accuracy of the Deauville score (DS) because the liver is often used as a reference organ in the scoring process. The DS relies on comparing the uptake of FDG in lymphoma lesions to the uptake in the liver. If liver steatosis is present, the liver's metabolic activity may be altered, which can affect the reliability of the comparison. This could lead to inaccurate assessment of treatment response. Experts, like Peters et al., have raised concerns about the use of the liver as a reference organ when steatosis is present, highlighting the need for careful consideration and potentially alternative methods for accurate scoring.

What is the role of blood glucose levels in Deauville scoring, and how are they managed?

Blood glucose levels can impact the accuracy of Deauville scoring because PET scans use FDG, a glucose analog. Elevated blood glucose levels can interfere with the uptake of FDG in lymphoma lesions, potentially affecting the Deauville score. Medical professionals are well-equipped to manage these challenges by carefully monitoring blood glucose levels. Maintaining optimal glucose control helps ensure that the PET scan results accurately reflect the metabolic activity of the lymphoma lesions, leading to more reliable assessments of treatment response and better patient outcomes. The use of SUL (Standardized Uptake Value Lean) instead of SUV (Standardized Uptake Value) also provides a more accurate comparison across different body compositions.

Explain the difference between SUV and SUL in the context of Deauville scoring, and why SUL is often preferred.

Both SUV (Standardized Uptake Value) and SUL (Standardized Uptake Value Lean) are measures used in PET scans to quantify FDG uptake in lymphoma lesions. SUV is a basic measure normalized to body weight or injected dose, while SUL refines SUV by normalizing FDG uptake to lean body mass. The key difference lies in how they account for body composition. SUL provides a more accurate comparison across different body compositions, making it a preferred metric in many clinical settings. By accounting for lean body mass, SUL helps minimize variations that can be introduced by differences in patient size and body composition, thereby increasing the reliability of the Deauville score for assessing treatment response.

How do medical professionals ensure accurate Deauville scoring despite potential influencing factors like liver steatosis and blood glucose fluctuations?

Medical professionals employ various strategies to ensure the accuracy of Deauville scoring despite potential influencing factors. They adhere to established guidelines for PET scan interpretation, meticulously monitor blood glucose levels, and utilize advanced imaging techniques. Recognizing that factors like liver steatosis and blood glucose can introduce variability, oncologists take steps to mitigate these effects. This includes careful consideration of the liver's condition and the use of appropriate reference standards such as SUL. Open communication with the healthcare team is also crucial, as it ensures that patients are informed about the potential influencing factors and the measures taken to ensure the most accurate assessment and the best possible treatment strategies for lymphoma patients. These steps allow for more reliable treatment decisions and optimized patient outcomes.