Alin Chirindel1, Muhammad Chaudhry2, Jaishri O Blakeley3, Richard Wahl4. 1. Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Radiation Oncology, University Medical Center, Frieburg, Germany, and German Cancer Research Center (DKFZ), Partner Site Freiburg, Freiburg, Germany. 2. Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia. 3. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; and. 4. Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri wahlr@mir.wustl.edu.
Abstract
UNLABELLED: (18)F-FDG PET/CT has shown increased accuracy, compared with morphologic imaging, in differentiating malignant peripheral nerve sheath tumors (MPNSTs) from benign neurofibromas (BNFs) in patients with neurofibromatosis type 1 (NF1). Delayed (18)F-FDG PET imaging typically enhances malignant tumor to background. Our goal was to compare the effectiveness of early (1-h) and delayed (4-h) (18)F-FDG PET/CT imaging in differentiating MPNSTs from BNFs in patients with NF1, with and without liver activity normalization. METHODS: NF1 patients presenting new symptoms or enlarging lesions were clinically evaluated with early and delayed (18)F-FDG PET/CT imaging. SULmax (maximum standardized uptake value derived for lean body) and SULmax/liver (lesion uptake adjusted to mean liver activity) were obtained for all sites identified with abnormal metabolic activity. Qualitative and quantitative evaluations, including receiver-operating-characteristic (ROC) comparison of early and delayed imaging sessions, were performed. Histopathology and clinical follow-up (1-9 y) were considered as a gold standard. RESULTS: Forty-one NF1 patients with early and delayed (18)F-FDG PET/CT scans were identified, and 93 lesions were retrospectively analyzed, representing 24 MPNSTs (all histologically confirmed) and 69 BNFs (26 histologically confirmed). Qualitative evaluation on early imaging showed sensitivity, specificity, positive predictive value, and negative predictive value for separating MPNSTs from BNFs of 91%, 84%, 67%, and 96% versus 91%, 81%, 63%, and 96%, respectively, on 4-h delayed imaging. The mean SULmax was significantly higher for MPNSTs than BNFs on both early scans (6.5 vs. 2.0, P < 0.01) and delayed imaging (8.3 vs. 2.3, P < 0.02). However, SULmax overlap between benign and malignant lesions persisted even after normalization to mean liver activity. ROC-derived best SULmax cutoffs were 3.2 on early (area under the curve, 0.973) and 4.1 on delayed scans (area under the curve, 0.978). ROC analysis for SULmax/liver improved test specificity (94% vs. 87%, P < 0.05) on early and (93% vs. 88%, P < 0.05) on delayed imaging. CONCLUSION: Qualitative interpretation of (18)F-FDG PET/CT discriminates MPNSTs from BNFs in NF1 patients with similar accuracy on both early and delayed imaging. Quantitative data showed better sensitivity on delayed acquisition and best test specificity with lesion SULmax normalization to liver activity, more so than with delayed imaging at 4 h.
UNLABELLED: (18)F-FDG PET/CT has shown increased accuracy, compared with morphologic imaging, in differentiating malignant peripheral nerve sheath tumors (MPNSTs) from benign neurofibromas (BNFs) in patients with neurofibromatosis type 1 (NF1). Delayed (18)F-FDG PET imaging typically enhances malignant tumor to background. Our goal was to compare the effectiveness of early (1-h) and delayed (4-h) (18)F-FDG PET/CT imaging in differentiating MPNSTs from BNFs in patients with NF1, with and without liver activity normalization. METHODS:NF1patients presenting new symptoms or enlarging lesions were clinically evaluated with early and delayed (18)F-FDG PET/CT imaging. SULmax (maximum standardized uptake value derived for lean body) and SULmax/liver (lesion uptake adjusted to mean liver activity) were obtained for all sites identified with abnormal metabolic activity. Qualitative and quantitative evaluations, including receiver-operating-characteristic (ROC) comparison of early and delayed imaging sessions, were performed. Histopathology and clinical follow-up (1-9 y) were considered as a gold standard. RESULTS: Forty-one NF1patients with early and delayed (18)F-FDG PET/CT scans were identified, and 93 lesions were retrospectively analyzed, representing 24 MPNSTs (all histologically confirmed) and 69 BNFs (26 histologically confirmed). Qualitative evaluation on early imaging showed sensitivity, specificity, positive predictive value, and negative predictive value for separating MPNSTs from BNFs of 91%, 84%, 67%, and 96% versus 91%, 81%, 63%, and 96%, respectively, on 4-h delayed imaging. The mean SULmax was significantly higher for MPNSTs than BNFs on both early scans (6.5 vs. 2.0, P < 0.01) and delayed imaging (8.3 vs. 2.3, P < 0.02). However, SULmax overlap between benign and malignant lesions persisted even after normalization to mean liver activity. ROC-derived best SULmax cutoffs were 3.2 on early (area under the curve, 0.973) and 4.1 on delayed scans (area under the curve, 0.978). ROC analysis for SULmax/liver improved test specificity (94% vs. 87%, P < 0.05) on early and (93% vs. 88%, P < 0.05) on delayed imaging. CONCLUSION: Qualitative interpretation of (18)F-FDG PET/CT discriminates MPNSTs from BNFs in NF1patients with similar accuracy on both early and delayed imaging. Quantitative data showed better sensitivity on delayed acquisition and best test specificity with lesion SULmax normalization to liver activity, more so than with delayed imaging at 4 h.
Authors: Christian Philipp Reinert; Martin Ulrich Schuhmann; Benjamin Bender; Isabel Gugel; Christian la Fougère; Jürgen Schäfer; Sergios Gatidis Journal: Eur J Nucl Med Mol Imaging Date: 2018-12-08 Impact factor: 9.236
Authors: Fernando Guedes; Gabriel Elias Sanches; Rosana Siqueira Brown; Rodrigo Salvador Vivas Cardoso; Ana Caroline Siquara-de-Sousa; Agostinho Ascenção; Antônio Carlos Iglesias Journal: Acta Neurochir (Wien) Date: 2021-03-10 Impact factor: 2.216
Authors: Kelsey L Watson; Ghadah A Al Sannaa; Christine M Kivlin; Davis R Ingram; Sharon M Landers; Christina L Roland; Janice N Cormier; Kelly K Hunt; Barry W Feig; B Ashleigh Guadagnolo; Andrew J Bishop; Wei-Lien Wang; John M Slopis; Ian E McCutcheon; Alexandar J Lazar; Keila E Torres Journal: J Neurosurg Date: 2016-04-01 Impact factor: 5.115
Authors: Stephen M Broski; Geoffrey B Johnson; Benjamin M Howe; Mark A Nathan; Doris E Wenger; Robert J Spinner; Kimberly K Amrami Journal: Skeletal Radiol Date: 2016-04-26 Impact factor: 2.199
Authors: Axel Van Der Gucht; Ouidad Zehou; Soraya Djelbani-Ahmed; Laurence Valeyrie-Allanore; Nicolas Ortonne; Pierre Brugières; Pierre Wolkenstein; Alain Luciani; Alain Rahmouni; Emilie Sbidian; Emmanuel Itti Journal: PLoS One Date: 2016-03-17 Impact factor: 3.240