European Radiology

, Volume 24, Issue 2, pp 405–412

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

  • Johannes Salamon
  • Simon Veldhoen
  • Ivayla Apostolova
  • Peter Bannas
  • Jin Yamamura
  • Jochen Herrmann
  • Reinhard E. Friedrich
  • Gerhard Adam
  • Victor F. Mautner
  • Thorsten Derlin
Nuclear Medicine

DOI: 10.1007/s00330-013-3020-x

Cite this article as:
Salamon, J., Veldhoen, S., Apostolova, I. et al. Eur Radiol (2014) 24: 405. doi:10.1007/s00330-013-3020-x

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 (rs = 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

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

An SUVmaxcut-off value may give false-positive results for benign plexiform neurofibromas

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

Keywords

NeurofibromatosisNF1MPNSTRatioPET

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Johannes Salamon
    • 1
    • 6
  • Simon Veldhoen
    • 1
    • 2
  • Ivayla Apostolova
    • 3
  • Peter Bannas
    • 1
  • Jin Yamamura
    • 1
  • Jochen Herrmann
    • 1
  • Reinhard E. Friedrich
    • 4
  • Gerhard Adam
    • 1
  • Victor F. Mautner
    • 5
  • Thorsten Derlin
    • 1
  1. 1.Department of Diagnostic and Interventional RadiologyUniversity Medical Centre Hamburg-EppendorfHamburgGermany
  2. 2.Department of Diagnostic and Interventional RadiologyUniversity Medical Centre WürzburgWürzburgGermany
  3. 3.Department of Radiology and Nuclear MedicineOtto-von-Guericke UniversityMagdeburgGermany
  4. 4.Department of Oral and Maxillofacial SurgeryUniversity Medical Centre Hamburg-EppendorfHamburgGermany
  5. 5.Department of NeurologyUniversity Medical Centre Hamburg-EppendorfHamburgGermany
  6. 6.Department of Diagnostic and Interventional RadiologyUniversity Hospital Hamburg-EppendorfHamburgGermany