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01-02-2014 | Nuclear Medicine

¹⁸F-FDG PET/CT for detection of malignant peripheral nerve sheath tumours in neurofibromatosis type 1: tumour-to-liver ratio is superior to an SUV_max cut-off

Authors: Johannes Salamon, Simon Veldhoen, Ivayla Apostolova, Peter Bannas, Jin Yamamura, Jochen Herrmann, Reinhard E. Friedrich, Gerhard Adam, Victor F. Mautner, Thorsten Derlin

Published in: European Radiology | Issue 2/2014

Abstract

Objectives

To evaluate the usefulness of normalising intra-tumour tracer accumulation on ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) to reference tissue uptake for characterisation of peripheral nerve sheath tumours (PNSTs) in neurofibromatosis type 1 (NF1) compared with the established maximum standardised uptake value (SUVmax) cut-off of >3.5.

Methods

Forty-nine patients underwent FDG PET/CT. Intra-tumour tracer uptake (SUVmax) was normalised to three different reference tissues (tumour-to-liver, tumour-to-muscle and tumour-to-fat ratios). Receiver operating characteristic (ROC) analyses were used out to assess the diagnostic performance. Histopathology and follow-up served as the reference standard.

Results

Intra-tumour tracer uptake correlated significantly with liver uptake (r _s = 0.58, P = 0.016). On ROC analysis, the optimum threshold for tumour-to-liver ratio was >2.6 (AUC = 0.9735). Both the SUVmax cut-off value of >3.5 and a tumour-to-liver ratio >2.6 provided a sensitivity of 100 %, but specificity was significantly higher for the latter (90.3 % vs 79.8 %; P = 0.013).

Conclusions

In patients with NF1, quantitative ¹⁸F-FDG PET imaging may identify malignant change in neurofibromas with high accuracy. Specificity could be significantly increased by using the tumour-to-liver ratio. The authors recommend further evaluation of a tumour-to-liver ratio cut-off value of >2.6 for diagnostic intervention planning.

Key Points

• ¹⁸ F-FDG PET/CT is used for detecting malignancy in PNSTs in NF1 patients

• An SUV _max cut-off value may give false-positive results for benign plexiform neurofibromas

• Specificity can be significantly increased using a tumour-to-liver ratio

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Title: 18F-FDG PET/CT for detection of malignant peripheral nerve sheath tumours in neurofibromatosis type 1: tumour-to-liver ratio is superior to an SUVmax cut-off
Authors: Johannes Salamon
Simon Veldhoen
Ivayla Apostolova
Peter Bannas
Jin Yamamura
Jochen Herrmann
Reinhard E. Friedrich
Gerhard Adam
Victor F. Mautner
Thorsten Derlin
Publication date: 01-02-2014
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 2/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-013-3020-x

At a glance: The STEP trials

Springer Medicine

¹⁸F-FDG PET/CT for detection of malignant peripheral nerve sheath tumours in neurofibromatosis type 1: tumour-to-liver ratio is superior to an SUV_max cut-off

Abstract

Objectives

Methods

Results

Conclusions

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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