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

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Marchioninistraße 15, 81377, Munich, Germany

    Wolfgang Peter Mueller, Henriette Ingrid Melzer, Peter Bartenstein & Thomas Pfluger

  2. Department of Paediatric Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany

    Irene Schmid

  3. Department of Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany

    Eva Coppenrath

Authors
  1. Wolfgang Peter Mueller
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  2. Henriette Ingrid Melzer
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  3. Irene Schmid
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  4. Eva Coppenrath
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  5. Peter Bartenstein
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  6. Thomas Pfluger
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Correspondence to Wolfgang Peter Mueller.

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Mueller, W.P., Melzer, H.I., Schmid, I. et al. The diagnostic value of 18F-FDG PET and MRI in paediatric histiocytosis. Eur J Nucl Med Mol Imaging 40, 356–363 (2013). https://doi.org/10.1007/s00259-012-2278-6

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  • DOI: https://doi.org/10.1007/s00259-012-2278-6

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