18 F-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
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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.
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.
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).
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.
• 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
- 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
Volume 24, Issue 2 , pp 405-412
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- 1. Department of Diagnostic and Interventional Radiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- 6. Department of Diagnostic and Interventional Radiology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- 2. Department of Diagnostic and Interventional Radiology, University Medical Centre Würzburg, Würzburg, Germany
- 3. Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
- 4. Department of Oral and Maxillofacial Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- 5. Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany