Intratumoral heterogeneity of F-18 FDG uptake differentiates between gastrointestinal stromal tumors and abdominal malignant lymphomas on PET/CT
Gastrointestinal stromal tumors (GISTs) and malignant lymphomas (MLs) in the abdomen are often observed as tumors of unknown origin on F-18 FDG PET/CT. The purpose of this study was to evaluate the intratumoral metabolic heterogeneity of F-18 FDG uptake on PET to determine if it might be helpful to discriminate between these tumors.
The F-18 FDG PET/CT findings of 21 large abdominal tumors were retrospectively evaluated (9 GISTs and 12 MLs). Intratumoral heterogeneity was evaluated by visual scoring (visual score: 0, homogeneous; 1, slightly heterogeneous; 2, moderately heterogeneous; 3, highly heterogeneous) and by the cumulative standardized uptake value (SUV) histograms on transaxial PET images at the maximal cross-sectional tumor diameter. Percent tumor areas above a threshold from 0 to 100% of the maximum SUV were plotted and the area under curve of the cumulative SUV histograms (AUC-CSH) was used as a heterogeneity index, where lower values corresponded with increased heterogeneity. Correlation between the visual score and the AUC-CSH was investigated by the Spearman’s rank test.
GISTs exhibited heterogeneous uptake of F-18 FDG, whereas MLs showed rather homogeneous uptake on visual analysis (visual score: 2.67 ± 0.50 and 0.58 ± 0.79, respectively; p < 0.001). The AUC-CSH was significantly lower for the GISTs than for the MLs (0.41 ± 0.14 and 0.64 ± 0.08, respectively; p < 0.001). Significant correlations were observed between the visual score and the AUC-CSH (ρ = −0.866, p < 0.001).
GISTs exhibited significantly heterogeneous intratumoral tracer uptake as compared with the MLs. Evaluation of the intratumoral heterogeneity of F-18 FDG uptake may help in the discrimination between these tumors.
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- Intratumoral heterogeneity of F-18 FDG uptake differentiates between gastrointestinal stromal tumors and abdominal malignant lymphomas on PET/CT
Annals of Nuclear Medicine
Volume 26, Issue 3 , pp 222-227
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- F-18 FDG PET
- Intratumoral heterogeneity
- Gastrointestinal stromal tumor
- Malignant lymphoma
- Cumulative standardized uptake value histograms
- Industry Sectors
- Author Affiliations
- 1. Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
- 4. Department of Nuclear Medicine, Osaka University Hospital, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
- 5. Immunology Frontier Research Center, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
- 6. Department of Radiology, Osaka University Hospital, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
- 2. Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- 3. Department of Radiology, Osaka University Graduate School of Medicine, Suita, Japan