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Diagnostic value of combined 18F-FDG PET/MRI for staging and restaging in paediatric oncology

European Journal of Nuclear Medicine and Molecular Imaging volume 39, pages 1745–1755 (2012)Cite this article

Abstract

Purpose

The present study compares the diagnostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and MRI to combined/registered 18F-FDG PET/MRI for staging and restaging in paediatric oncology.

Methods

Over 8 years and 2 months, 270 18F-FDG PET and 270 MRI examinations (mean interval 5 days) were performed in 132 patients with proven (n = 117) or suspected (n = 15) malignant disease: solid tumours (n = 64), systemic malignancy (n = 53) and benign disease (n = 15). A total of 259 suspected tumour lesions were analysed retrospectively during primary diagnosis and 554 lesions during follow-up. Image analysis was performed separately on each modality, followed by analysis of combined and registered 18F-FDG PET/MRI imaging.

Results

A total of 813 lesions were evaluated and confirmed by histopathology (n = 158) and/or imaging follow-up (n = 655) after 6 months. In the separate analysis of 18F-FDG PET and MRI, sensitivity was 86 %/94 % and specificity 85 %/38 %. Combined/registered 18F-FDG PET/MRI led to a sensitivity of 97 %/97 % and specificity of 81 %/82 %. False-positive results (18F-FDG PET n = 69, MRI n = 281, combined 18F-FDG PET/MRI n = 85, registered 18F-FDG PET/MRI n = 80) were due to physiological uptake or post-therapeutic changes. False-negative results (18F-FDG PET n = 50, MRI n = 20, combined 18F-FDG PET/MRI n = 11, registered 18F-FDG PET/MRI n = 11) were based on low uptake or minimal morphological changes. Examination-based evaluation during follow-up showed a sensitivity/specificity of 91 %/81 % for 18F-FDG PET, 93 %/30 % for MRI and 96 %/72 % for combined 18F-FDG PET/MRI.

Conclusion

For the detection of single tumour lesions, registered 18F-FDG PET/MRI proved to be the methodology of choice for adequate tumour staging. In the examination-based evaluation, MRI alone performed better than 18F-FDG PET and combined/registered imaging during primary diagnosis. At follow-up, however, the examination-based evaluation demonstrated a superiority of 18F-FDG PET alone.

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Affiliations

  1. Department of Nuclear Medicine, Ludwig Maximilians University of Munich, Ziemssenstraße 1, 80336, Munich, Germany

    Thomas Pfluger, Henriette I. Melzer, Wolfgang P. Mueller & Peter Bartenstein

  2. Department of Radiology, Ludwig Maximilians University of Munich, Munich, Germany

    Eva Coppenrath

  3. Department of Paediatric Oncology/Haematology, Ludwig Maximilians University of Munich, Munich, Germany

    Michael H. Albert & Irene Schmid

Authors
  1. Thomas Pfluger
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  2. Henriette I. Melzer
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  3. Wolfgang P. Mueller
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  4. Eva Coppenrath
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Correspondence to Henriette I. Melzer.

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Pfluger, T., Melzer, H.I., Mueller, W.P. et al. Diagnostic value of combined 18F-FDG PET/MRI for staging and restaging in paediatric oncology. Eur J Nucl Med Mol Imaging 39, 1745–1755 (2012). https://doi.org/10.1007/s00259-012-2228-3

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  • DOI: https://doi.org/10.1007/s00259-012-2228-3

Keywords

  • Paediatric oncology
  • 18F-FDG PET
  • MRI
  • Combined/registered image analysis