{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T16:51:50Z","timestamp":1782492710033,"version":"3.54.5"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background\/Objectives<\/jats:title>\n                    <jats:p>Maximum tumor dissemination (Dmax) measured by positron-emission tomography\/computed tomography (PET\/CT) is a semiquantitative parameter recently introduced with potential prognostic role in several oncological diseases. It is defined as a three-dimensional feature that represents the maximal distance between the two farthest hypermetabolic PET lesions. The aim of our systematic review is to investigate the effective role of Dmax in the management of oncological patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The current systematic review was carried out following a preset protocol, and the \u201cPreferred Reporting Items for a Systematic Review and Meta-Analysis\u201d served as a guideline for its development. A comprehensive search of the PubMed\/MEDLINE, Embase and Cochrane library databases was conducted until August 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 37 studies were included in our research. Lymphoma was the most frequent cancer investigated, followed by prostate cancer, lung cancer and breast cancer. Despite their heterogeneity, most studies showed a significant prognostic role of Dmax in predicting overall survival (OS) and progression free survival (PFS). The combination of Dmax with other PET features, especially MTV, seemed to be useful to stratify patients risk of relapse and\/or death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite several limitations affecting this analysis, especially related to the heterogeneity of the studies included, PET\/CT seems to have a prognostic impact in several oncological diseases, especially in lymphoma. However, few methodological issues still need to be solved before we can implement Dmax in clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1726567","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T07:35:49Z","timestamp":1767598549000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The prognostic role of maximum tumor dissemination derived by PET\/CT in oncological diseases: a systematic review"],"prefix":"10.3389","volume":"12","author":[{"given":"Slavko","family":"Tasevski","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Treglia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Marin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Bertagna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Albano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"100006","DOI":"10.1016\/j.eanmj.2025.100006","volume":"1","author":"Boellaard","year":"2025","journal-title":"EANM J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1515040","DOI":"10.3389\/fmed.2024.1515040","article-title":"Semiquantitative 2-[18F]FDG PET\/CT-based parameters role in lymphoma","volume":"11","author":"Albano","year":"2024","journal-title":"Front Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e340","DOI":"10.1016\/j.clml.2021.11.006","article-title":"Prognostic role of \u201cradiological\u201d sarcopenia in lymphoma: a systematic review","volume":"22","author":"Albano","year":"2022","journal-title":"Clin Lymphoma Myeloma Leuk."},{"key":"B4","doi-asserted-by":"publisher","first-page":"523","DOI":"10.2967\/jnumed.116.186353","article-title":"Repeatability of SUV in oncologic 18F-FDG PET","volume":"58","author":"Lodge","year":"2017","journal-title":"J Nucl Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"123","DOI":"10.3390\/biomedicines13010123","article-title":"PET-Assessed metabolic tumor volume across the spectrum of solid-organ malignancies: a review of the literature","volume":"13","author":"Agarwal","year":"2025","journal-title":"Biomedicines."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.2967\/jnumed.124.267789","article-title":"International benchmark for total metabolic tumor volume measurement in baseline 18F-FDG PET\/CT of lymphoma patients: a milestone toward clinical implementation","volume":"65","author":"Boellaard","year":"2024","journal-title":"J. Nucl. Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"2494","DOI":"10.3390\/cancers15092494","article-title":"18F-FDG PET\/CT maximum tumor dissemination (Dmax) in lymphoma: a new prognostic factor?","volume":"15","author":"Albano","year":"2023","journal-title":"Cancers."},{"key":"B8","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ."},{"key":"B9","doi-asserted-by":"publisher","first-page":"529","DOI":"10.7326\/0003-4819-155-8-201110180-00009","article-title":"QUADAS-2 Group. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies","volume":"155","author":"Whiting","year":"2011","journal-title":"Ann Intern Med."},{"key":"B10","doi-asserted-by":"publisher","first-page":"40","DOI":"10.2967\/jnumed.119.229450","article-title":"18F-FDG PET dissemination features in diffuse large B-cell lymphoma are predictive of outcome","volume":"61","author":"Cottereau","year":"2020","journal-title":"J. Nucl. Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"6347404","DOI":"10.1155\/2021\/6347404","article-title":"Radiomic features of 18F-FDG PET in hodgkin lymphoma are predictive of outcomes","volume":"2021","author":"Zhou","year":"2021","journal-title":"Contrast Media Mol Imaging."},{"key":"B12","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1016\/j.annonc.2020.11.019","article-title":"Risk stratification in diffuse large B-cell lymphoma using lesion dissemination and metabolic tumor burden calculated from baseline PET\/CT","volume":"32","author":"Cottereau","year":"2021","journal-title":"Ann. Oncol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"3998","DOI":"10.3390\/cancers13163998","article-title":"New approaches in characterization of lesions dissemination in DLBCL patients on baseline PET\/CT","volume":"13","author":"Cottereau","year":"2021","journal-title":"Cancers."},{"key":"B14","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1002\/hon.3025","article-title":"Prognostic value of lesion dissemination in doxorubicin, bleomycin, vinblastine, and dacarbazine-treated, interimPET-negative classical Hodgkin Lymphoma patients: a radio-genomic study","volume":"40","author":"Durmo","year":"2022","journal-title":"Hematol Oncol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"943151","DOI":"10.3389\/fonc.2022.943151","article-title":"Prediction of prognosis and pathologic grade in follicular lymphoma using 18F-FDG PET\/CT","volume":"12","author":"Li","year":"2022","journal-title":"Front Oncol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1097\/MNM.0000000000001539","article-title":"Prediction of early biochemical response after 177Lu-PSMA radioligand therapy with 68Ga-PSMA PET, a different perspective with quantitative parameters","volume":"43","author":"Aksu","year":"2022","journal-title":"Nucl Med Commun"},{"key":"B17","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1007\/s12149-021-01705-5","article-title":"Dual time point imaging of staging PSMA PET\/CT quantification; spread and radiomic analyses","volume":"36","author":"Aksu","year":"2022","journal-title":"Ann Nucl Med."},{"key":"B18","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1007\/s00259-021-05480-3","article-title":"18F-FDG PET baseline radiomics features improve the prediction of treatment outcome in diffuse large B-cell lymphoma","volume":"49","author":"Eertink","year":"2022","journal-title":"Eur J Nucl Med Mol Imaging."},{"key":"B19","doi-asserted-by":"publisher","first-page":"4642","DOI":"10.1007\/s00259-022-05916-4","article-title":"Comparing lesion and feature selections to predict progression in newly diagnosed DLBCL patients with FDG PET\/CT radiomics features","volume":"49","author":"Eertink","year":"2022","journal-title":"Eur J Nucl Med Mol Imaging."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1925","DOI":"10.2967\/jnumed.121.263501","article-title":"18F-FDG PET maximum-intensity projections and artificial intelligence: a win-win combination to easily measure prognostic biomarkers in DLBCL patients","volume":"63","author":"Girum","year":"2022","journal-title":"J. Nucl. Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1002\/jha2.610","article-title":"The added prognostic values of baseline PET dissemination parameter in patients with angioimmunoblastic T-cell lymphoma","volume":"4","author":"Gong","year":"2023","journal-title":"EJHaem."},{"key":"B22","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1080\/10428194.2022.2131415","article-title":"Woei-A-Jin FJSH, Laenen A, Tousseyn T, et al","volume":"64","author":"Vergote","year":"2023","journal-title":"Leuk Lymphoma"},{"key":"B23","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1007\/s00277-023-05547-1","article-title":"A different perspective on PET\/CT before treatment in patients with Hodgkin lymphoma: importance of volumetric and dissemination parameters","volume":"103","author":"Aksu","year":"2024","journal-title":"Ann Hematol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1186\/s12880-023-01138-8","article-title":"Predictive value of Dmax and %\u0394SUVmax of 18F-FDG PET\/CT for the prognosis of patients with diffuse large B-cell lymphoma","volume":"23","author":"Dang","year":"2023","journal-title":"BMC Med Imaging."},{"key":"B25","doi-asserted-by":"publisher","first-page":"13111","DOI":"10.1038\/s41598-023-40218-1","article-title":"An artificial intelligence method using FDG PET to predict treatment outcome in diffuse large B cell lymphoma patients","volume":"13","author":"Ferr\u00e1ndez","year":"2023","journal-title":"Sci Rep."},{"key":"B26","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1007\/s13139-022-00782-2","article-title":"PET\/CT maximum tumor dissemination to predict recurrence in patients with diffuse large B-Cell lymphoma","volume":"57","author":"Jo","year":"2023","journal-title":"Nucl Med Mol Imaging."},{"key":"B27","doi-asserted-by":"publisher","first-page":"16734","DOI":"10.1002\/cam4.6295","article-title":"A nomogram for predicting the rapid progression of diffuse large B-cell lymphoma established by combining baseline PET\/CT total metabolic tumor volume, lesion diffusion, and TP53 mutations","volume":"12","author":"Liu","year":"2023","journal-title":"Cancer Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"3115","DOI":"10.1007\/s00277-023-05336-w","article-title":"Prediction nomogram based on 18F-FDG PET\/CT and clinical parameters for patients with diffuse large B-cell lymphoma","volume":"102","author":"Peng","year":"2023","journal-title":"Ann Hematol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"e861","DOI":"10.1097\/HS9.0000000000000861","article-title":"Risk factors of progression in low-tumor burden follicular lymphoma initially managed by watch and wait in the era of PET and rituximab","volume":"7","author":"Rodier","year":"2023","journal-title":"Hemasphere."},{"key":"B30","doi-asserted-by":"publisher","first-page":"2904","DOI":"10.1016\/j.acra.2023.03.027","article-title":"PET\/CT tumor dissemination characteristic predicts the outcome of first-line systemic therapy in non-small cell lung cancer","volume":"30","author":"Tan","year":"2023","journal-title":"Acad Radiol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1186\/s12885-023-11333-z","article-title":"Dissemination feature based on PET\/CT is a risk factor for diffuse large B cell lymphoma patients outcome","volume":"23","author":"Wang","year":"2023","journal-title":"BMC Cancer."},{"key":"B32","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1007\/s11604-023-01398-y","article-title":"Prognostic value of 18F-FDG lesion dissemination features in patients with peripheral T-cell lymphoma (PTCL)","volume":"41","author":"Xie","year":"2023","journal-title":"Jpn J Radiol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"110798","DOI":"10.1016\/j.ejrad.2023.110798","article-title":"Prognostic value of metabolic tumor volume and lesion dissemination from baseline PET\/CT in patients with diffuse large B-cell lymphoma: further risk stratification of the group with low-risk and high-risk NCCN-IPI","volume":"163","author":"Xu","year":"2023","journal-title":"Eur J Radiol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"2419","DOI":"10.1007\/s00277-024-05672-5","volume":"103","author":"Albano","year":"2024","journal-title":"Ann Hematol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/s40644-024-00727-2","article-title":"Baseline and early 18F-FDG PET\/CT evaluations as predictors of progression-free survival in metastatic breast cancer patients treated with targeted anti-CDK therapy","volume":"24","author":"Lasnon","year":"2024","journal-title":"Cancer Imaging."},{"key":"B36","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1097\/RLU.0000000000004930","article-title":"Prognostic value of baseline tumor burden and tumor dissemination extracted from 18 F-FDG PET\/CT in a cohort of adult patients with early or advanced Hodgkin lymphoma","volume":"49","author":"Mouheb","year":"2024","journal-title":"Clin Nucl Med."},{"key":"B37","doi-asserted-by":"publisher","first-page":"5583","DOI":"10.1007\/s00277-024-06071-6","article-title":"Development and validation of prognostic models based on 18F-FDG PET radiomics, metabolic parameters, and clinical factors for elderly DLBCL patients","volume":"103","author":"Yang","year":"2024","journal-title":"Ann Hematol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1007\/s12149-025-02026-7","article-title":"The prognostic role of staging [18F]PSMA-1007 PET\/CT volumetric and dissemination features in prostate cancer","volume":"39","author":"Albano","year":"2025","journal-title":"Ann Nucl Med."},{"key":"B39","doi-asserted-by":"publisher","first-page":"e70009","DOI":"10.1002\/hon.70009","article-title":"Prognostic role of pretreatment tumor burden and dissemination features from 2-[18F]FDG PET\/CT in advanced mantle cell lymphoma","volume":"43","author":"Albano","year":"2025","journal-title":"Hematol Oncol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1007\/s12672-025-02126-w","article-title":"Evaluating \u0394MTV%, \u0394Dmax%, and %\u0394SUVmax of 18F-FDG PET\/CT for mid-treatment efficacy and prognosis in diffuse large B-cell lymphoma","volume":"16","author":"Cui","year":"2025","journal-title":"Discover Oncology."},{"key":"B41","doi-asserted-by":"publisher","first-page":"972","DOI":"10.1097\/MNM.0000000000002023","article-title":"Assessment of quantitative staging PET\/computed tomography parameters using machine learning for early detection of progression in diffuse large B-cell lymphoma","volume":"46","author":"Aksu","year":"2025","journal-title":"Nucl Med Commun."},{"key":"B42","doi-asserted-by":"publisher","first-page":"2207","DOI":"10.1038\/s41375-025-02688-2","article-title":"Integration of [18F]FDG-PET radiomics with liquid biopsy improves outcome prediction in newly diagnosed diffuse large B-cell lymphoma","volume":"39","author":"Dondolin","year":"2025","journal-title":"Leukemia."},{"key":"B43","doi-asserted-by":"publisher","first-page":"2468","DOI":"10.21037\/qims-24-1504","article-title":"Integration of PET\/CT parameters and a clinical variable to predict the risk of progression of disease within 24 months (POD24) in follicular lymphoma","volume":"15","author":"Jiang","year":"2025","journal-title":"Quant Imaging Med Surg."},{"key":"B44","doi-asserted-by":"publisher","first-page":"477","DOI":"10.3390\/biomedicines13020477","article-title":"Prognostic value of tumor dissemination (Dmax) derived from basal 18F-FDG positron emission tomography\/computed tomography in patients with advanced non-small-cell lung cancer","volume":"13","author":"Pellegrino","year":"2025","journal-title":"Biomedicines."},{"key":"B45","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1007\/s00259-024-06929-x","article-title":"Pre-treatment [18F]FDG PET\/CT biomarkers for the prediction of antibody\u2013drug conjugates efficacy in metastatic breast cancer","volume":"52","author":"Seban","year":"2025","journal-title":"Eur J Nucl Med Mol Imaging."},{"key":"B46","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/s40644-025-00888-8","article-title":"Prognostic value of early post-treatment 18F-FDG PET\/CT in diffuse large B-cell lymphoma patients receiving chimeric antigen receptor T-cell therapy","volume":"25","author":"Mirshahvalad","year":"2025","journal-title":"Cancer Imaging."},{"key":"B47","doi-asserted-by":"publisher","first-page":"4786","DOI":"10.1158\/0008-5472.CAN-18-0125","article-title":"LIFEx: a freeware for radiomic feature calculation in multimodality imaging to accelerate advances in the characterization of tumor heterogeneity","volume":"78","author":"Nioche","year":"2018","journal-title":"Cancer Res."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1726567\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T07:35:50Z","timestamp":1767598550000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1726567\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,5]]},"references-count":47,"alternative-id":["10.3389\/fmed.2025.1726567"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1726567","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,5]]},"article-number":"1726567"}}