Deauville 5-Point Scale with Lugano Response

The Deauville five-point scale grades the hottest residual uptake visually: 1 = no uptake above background, 2 = up to mediastinal blood pool, 3 = above mediastinum but up to liver, 4 = moderately above liver, 5 = markedly above liver (at least 2-3 times the liver SUVmax) or new lesions, with X appended for new uptake unlikely to be lymphoma. The Lugano classification then assigns response: scores 1-3 (with or without a residual mass) are a complete metabolic response; 4-5 with reduced uptake versus baseline is a partial metabolic response; 4-5 without significant change is no metabolic response; and 4-5 with increased uptake or new FDG-avid foci consistent with lymphoma is progressive metabolic disease. Scores of 3 or less are generally treated as PET-negative, although trials of treatment de-escalation may conservatively count a score of 3 as inadequate. Optional SUV entries provide a suggested score for cross-checking the visual read.