Stylized illustration of a liver with lymphatic vessels and PET scan overlay.

Deauville Scoring in Lymphoma: Why Liver Uptake Matters More Than You Think

Avery Sinclair in Health & Wellness November 2025 • 4 min read.

"Unpacking the Debate: How Liver Steatosis and Glucose Levels Can Influence Lymphoma Treatment Assessment."

In the landscape of lymphoma treatment assessment, Deauville scoring (DS) stands as a pivotal tool, guiding therapeutic strategies and prognostic evaluations. The core of this scoring system relies on comparing the uptake of radioactive tracers in lymphoma lesions relative to a reference organ, often the liver. However, the reliability of the liver as a consistent benchmark has sparked considerable debate, particularly concerning the influence of factors like liver steatosis and variations in blood glucose levels.

A recent discourse, ignited by Peters et al., challenges the conventional use of the liver in Deauville scoring, questioning whether its inherent variability compromises the accuracy of lymphoma staging and treatment response assessment. This article delves into the heart of this discussion, examining the arguments, counterarguments, and clinical implications surrounding the use of liver uptake as a reference standard.

Drawing upon insights from a reply to the editor by Nicolas Aide, Thibault Salomon, and Charline Lasnon, we aim to clarify the complexities of Deauville scoring. Our goal is to provide accessible information that empowers patients and healthcare professionals alike to navigate the nuances of lymphoma management with greater confidence and understanding.

The SULmax vs. SUVmax Debate: Does It Really Matter?

Stylized illustration of a liver with lymphatic vessels and PET scan overlay.

At the forefront of the Deauville scoring discussion is the choice between standardized uptake value (SUV) metrics: SULmax (lean body mass) and SUVmax (maximum). While seemingly technical, this distinction touches on how tracer uptake is normalized within the body, potentially influencing the final Deauville score. Nicolas Aide and colleagues concur with Peters et al. that, in practice, the specific SUV metric used has minimal impact on the DS. The critical factor remains the ratio between lymphoma lesion uptake and liver uptake, irrespective of whether SULmax or SUVmax is employed.

The preference for SULmax in certain guidelines stems from its adjustment for lean body mass, theoretically reducing variability related to body composition. However, recognizing the widespread use of SUVmax in clinical settings, researchers often provide both sets of results. This dual reporting ensures comprehensive data interpretation, acknowledging that similar correlations are expected regardless of the chosen metric.

SULmax: Standardized Uptake Value, lean body mass.
SUVmax: Maximum Standardized Uptake Value.
DS: Deauville Score.

Ultimately, the SULmax vs. SUVmax debate underscores the importance of standardized protocols and consistent application of guidelines. While subtle differences may exist, the overarching consensus emphasizes the ratio of tumor-to-liver uptake as the primary determinant of the Deauville score.

Navigating the Nuances: A Practical Approach

In conclusion, while the debate surrounding liver uptake in Deauville scoring continues to evolve, a practical and informed approach remains paramount. By understanding the potential influence of factors like steatosis and glucose variability, healthcare professionals can refine their interpretation of PET scan results, ensuring accurate staging and treatment response assessment. For patients, open communication with their medical team is essential, fostering a collaborative approach to lymphoma management. As research progresses and new parameters emerge, the Deauville scoring system will undoubtedly adapt, further optimizing its utility in the fight against lymphoma.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1007/s00259-018-4087-z, Alternate LINK

Title: Reply To The Letter To The Editor From Peters Et Al: On The Use Of The Liver As A Reference Organ For Deauville Scoring In Lymphoma Patients And How It May Be Affected By Liver Steatosis

Subject: Radiology, Nuclear Medicine and imaging

Journal: European Journal of Nuclear Medicine and Molecular Imaging

Publisher: Springer Science and Business Media LLC

Authors: Nicolas Aide, Thibault Salomon, Charline Lasnon

Published: 2018-07-14

Everything You Need To Know

What is Deauville scoring and why is it important in lymphoma treatment?

Deauville scoring (DS) is a crucial tool in lymphoma treatment assessment. It helps guide therapeutic strategies and evaluate how well the treatment is working. DS relies on comparing the uptake of radioactive tracers in lymphoma lesions to a reference organ, frequently the liver. This comparison helps doctors understand the extent of the disease and monitor its response to treatment. Accurate Deauville scores are essential for making informed decisions about patient care and predicting outcomes.

Why is the liver's role in Deauville scoring being questioned?

The reliability of the liver as a reference in Deauville scoring is under debate because factors like liver steatosis and variations in blood glucose levels can influence the uptake of radioactive tracers. These factors can make the liver's uptake inconsistent, potentially affecting the accuracy of the Deauville score. Recent discussions, highlighted by Peters et al., suggest that these variations could compromise the accuracy of lymphoma staging and treatment response assessment.

What's the difference between SULmax and SUVmax in Deauville scoring, and does it really matter?

SULmax (Standardized Uptake Value, lean body mass) and SUVmax (Maximum Standardized Uptake Value) are both methods of measuring tracer uptake in the body, used in Deauville scoring. The difference lies in how the uptake is normalized. SULmax adjusts for lean body mass, theoretically reducing variability related to body composition. However, Nicolas Aide and colleagues, concur with Peters et al. that the specific SUV metric used has minimal impact on the Deauville Score. The key factor remains the ratio between lymphoma lesion uptake and liver uptake. Both SULmax and SUVmax can be used, with similar correlations expected.

How can liver steatosis and blood glucose levels impact PET scan results used in Deauville scoring?

Liver steatosis and blood glucose levels can significantly affect PET scan results, potentially skewing the accuracy of Deauville scoring. Liver steatosis, or fatty liver, can alter the liver's uptake of the radioactive tracer, making it an unreliable reference. Similarly, blood glucose levels can influence the activity of the tracer. These variations can make it difficult to accurately compare lymphoma lesion uptake to liver uptake, leading to less precise staging and treatment response assessments.

What practical approach should healthcare professionals and patients take regarding Deauville scoring?

Healthcare professionals should understand how factors like steatosis and glucose variability can influence the interpretation of PET scan results to ensure accurate staging and treatment response assessment. Open communication is vital for patients with their medical teams, fostering a collaborative approach to lymphoma management. Standardized protocols and consistent application of guidelines are critical. Continued research and adaptation of the Deauville scoring system will further optimize its effectiveness in lymphoma management.