Advertisement

The diagnostic value of 18F-FDG PET and MRI in paediatric histiocytosis

  • Wolfgang Peter MuellerEmail author
  • Henriette Ingrid Melzer
  • Irene Schmid
  • Eva Coppenrath
  • Peter Bartenstein
  • Thomas Pfluger
Original Article

Abstract

Purpose

To analyse the diagnostic value of 18F-FDG PET and MRI for the evaluation of active lesions in paediatric Langerhans cell histiocytosis.

Methods

We compared 21 18F-FDG PET scans with 21 MRI scans (mean time interval 17 days) in 15 patients (11 male, 4 female, age range 4 months to 19 years) with biopsy-proven histiocytosis. Primary criteria for the lesion-based analysis were signs of vital histiocyte infiltrates (bone marrow oedema and contrast enhancement for MRI; SUV greater than the mean SUV of the right liver lobe for PET). PET and MR images were analysed separately and side-by-side. The results were validated by biopsy or follow-up scans after more than 6 months.

Results

Of 53 lesions evaluated, 13 were confirmed by histology and 40 on follow-up investigations. The sensitivity and specificity of PET were 67 % and 76 % and of MRI were 81 % and 47 %, respectively. MRI showed seven false-positive bone lesions after successful chemotherapy. PET showed five false-negative small bone lesions, one false-negative lesion of the skull and three false-negative findings for intracerebral involvement. PET showed one false-positive lesion in the lymphoid tissue of the head and neck region and two false-positive bone lesions after treatment. Combined PET/MR analysis decreased the number of false-negative findings on primary staging, whereas no advantage over PET alone was seen in terms of false-positive or false-negative results on follow-up.

Conclusion

Our retrospective analysis suggests a pivotal role of 18F-FDG PET in lesion follow-up due to a lower number of false-positive findings after chemotherapy. MRI showed a higher sensitivity and is indispensable for primary staging, evaluation of brain involvement and biopsy planning. Combined MRI/PET analysis improved sensitivity by decreasing the false-negative rate during primary staging indicating a future role of simultaneous whole-body PET/MRI for primary investigation of paediatric histiocytosis.

Keywords

PET/MRI MR/PET Histiocytosis Paediatric oncology 

Notes

Conflicts of interest

None.

Financial support

None.

References

  1. 1.
    Hoover KB, Rosenthal DI, Mankin H. Langerhans cell histiocytosis. Skeletal Radiol. 2007;36:95–104.PubMedCrossRefGoogle Scholar
  2. 2.
    Grois N, Potschger U, Prosch H, Minkov M, Arico M, Braier J, et al. Risk factors for diabetes insipidus in langerhans cell histiocytosis. Pediatr Blood Cancer. 2006;46:228–33.PubMedCrossRefGoogle Scholar
  3. 3.
    Minkov M, Grois N, Heitger A, Potschger U, Westermeier T, Gadner H. Response to initial treatment of multisystem Langerhans cell histiocytosis: an important prognostic indicator. Med Pediatr Oncol. 2002;39:581–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Gadner H, Grois N, Arico M, Broadbent V, Ceci A, Jakobson A, et al. A randomized trial of treatment for multisystem Langerhans’ cell histiocytosis. J Pediatr. 2001;138:728–34.PubMedCrossRefGoogle Scholar
  5. 5.
    Schmidt S, Eich G, Geoffray A, Hanquinet S, Waibel P, Wolf R, et al. Extraosseous langerhans cell histiocytosis in children. Radiographics. 2008;28:707–26.PubMedCrossRefGoogle Scholar
  6. 6.
    Phillips M, Allen C, Gerson P, McClain K. Comparison of FDG-PET scans to conventional radiography and bone scans in management of Langerhans cell histiocytosis. Pediatr Blood Cancer. 2009;52:97–101.PubMedCrossRefGoogle Scholar
  7. 7.
    Binkovitz LA, Olshefski RS, Adler BH. Coincidence FDG-PET in the evaluation of Langerhans’ cell histiocytosis: preliminary findings. Pediatr Radiol. 2003;33:598–602.PubMedCrossRefGoogle Scholar
  8. 8.
    Meyer JS, De Camargo B. The role of radiology in the diagnosis and follow-up of Langerhans cell histiocytosis. Hematol Oncol Clin North Am. 1998;12:307–26.PubMedCrossRefGoogle Scholar
  9. 9.
    Azouz EM, Saigal G, Rodriguez MM, Podda A. Langerhans’ cell histiocytosis: pathology, imaging and treatment of skeletal involvement. Pediatr Radiol. 2005;35:103–15.PubMedCrossRefGoogle Scholar
  10. 10.
    Pavlik M, Bloom DA, Ozgonenel B, Sarnaik SA. Defining the role of magnetic resonance imaging in unifocal bone lesions of langerhans cell histiocytosis. J Pediatr Hematol Oncol. 2005;27:432–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Grois N, Fahrner B, Arceci RJ, Henter JI, McClain K, Lassmann H, et al. Central nervous system disease in Langerhans cell histiocytosis. J Pediatr. 2010;156:873–81.PubMedCrossRefGoogle Scholar
  12. 12.
    Bombardieri E, Aktolun C, Baum RP, Bishof-Delaloye A, Buscombe J, Chatal JF, et al. FDG-PET: procedure guidelines for tumour imaging. Eur J Nucl Med Mol Imaging. 2003;30:BP115–24.PubMedGoogle Scholar
  13. 13.
    Kaste SC, Rodriguez-Galindo C, McCarville ME, Shulkin BL. PET-CT in pediatric Langerhans cell histiocytosis. Pediatr Radiol. 2007;37:615–22.PubMedCrossRefGoogle Scholar
  14. 14.
    Blum R, Seymour JF, Hicks RJ. Role of 18FDG-positron emission tomography scanning in the management of histiocytosis. Leuk Lymphoma. 2002;43:2155–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Lee HJ, Ahn BC, Lee SW, Lee J. The usefulness of F-18 fluorodeoxyglucose positron emission tomography/computed tomography in patients with Langerhans cell histiocytosis. Ann Nucl Med. 2012. doi: 10.1007/s12149-012-0635-y
  16. 16.
    Gadner H, Grois N, Potschger U, Minkov M, Arico M, Braier J, et al. Improved outcome in multisystem Langerhans cell histiocytosis is associated with therapy intensification. Blood. 2008;111:2556–62.PubMedCrossRefGoogle Scholar
  17. 17.
    Buchler T, Cervinek L, Belohlavek O, Kantorova I, Mechl M, Nebesky T, et al. Langerhans cell histiocytosis with central nervous system involvement: follow-up by FDG-PET during treatment with cladribine. Pediatr Blood Cancer. 2005;44:286–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Krajicek BJ, Ryu JH, Hartman TE, Lowe VJ, Vassallo R. Abnormal fluorodeoxyglucose PET in pulmonary Langerhans cell histiocytosis. Chest. 2009;135:1542–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Szturz P, Rehak Z, Koukalova R, Adam Z, Krejci M, Pour L, et al. Measuring diffuse metabolic activity on FDG-PET/CT: new method for evaluating Langerhans cell histiocytosis activity in pulmonary parenchyma. Nucl Med Biol. 2012;39:429–36.PubMedCrossRefGoogle Scholar
  20. 20.
    Mentzel HJ, Kentouche K, Sauner D, Fleischmann C, Vogt S, Gottschild D, et al. Comparison of whole-body STIR-MRI and 99mTc-methylene-diphosphonate scintigraphy in children with suspected multifocal bone lesions. Eur Radiol. 2004;14:2297–302.PubMedCrossRefGoogle Scholar
  21. 21.
    Goo HW, Yang DH, Ra YS, Song JS, Im HJ, Seo JJ, et al. Whole-body MRI of Langerhans cell histiocytosis: comparison with radiography and bone scintigraphy. Pediatr Radiol. 2006;36:1019–31.PubMedCrossRefGoogle Scholar
  22. 22.
    Kilborn TN, Teh J, Goodman TR. Paediatric manifestations of Langerhans cell histiocytosis: a review of the clinical and radiological findings. Clin Radiol. 2003;58:269–78.PubMedCrossRefGoogle Scholar
  23. 23.
    Kellenberger CJ, Epelman M, Miller SF, Babyn PS. Fast STIR whole-body MR imaging in children. Radiographics. 2004;24:1317–30.PubMedCrossRefGoogle Scholar
  24. 24.
    Grois N, Tsunematsu Y, Barkovich AJ, Favara BE. Central nervous system disease in Langerhans cell histiocytosis. Br J Cancer Suppl. 1994;23:S24–8.PubMedGoogle Scholar
  25. 25.
    Ohno Y, Koyama H, Yoshikawa T, Nishio M, Matsumoto S, Iwasawa T, et al. Pulmonary magnetic resonance imaging for airway diseases. J Thorac Imaging. 2011;26:301–16.PubMedCrossRefGoogle Scholar
  26. 26.
    Drzezga A, Souvatzoglou M, Eiber M, Beer AJ, Furst S, Martinez-Moller A, et al. First clinical experience with integrated whole-body PET/MR: comparison to PET/CT in patients with oncologic diagnoses. J Nucl Med. 2012;53:845–55.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Wolfgang Peter Mueller
    • 1
    Email author
  • Henriette Ingrid Melzer
    • 1
  • Irene Schmid
    • 2
  • Eva Coppenrath
    • 3
  • Peter Bartenstein
    • 1
  • Thomas Pfluger
    • 1
  1. 1.Department of Nuclear MedicineLudwig-Maximilians-University of MunichMunichGermany
  2. 2.Department of Paediatric OncologyLudwig-Maximilians-University of MunichMunichGermany
  3. 3.Department of RadiologyLudwig-Maximilians-University of MunichMunichGermany

Personalised recommendations