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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

  • Nuclear Medicine
  • Published:
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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 (r s  = 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

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

• An SUV max cut-off value may give false-positive results for benign plexiform neurofibromas

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

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Acknowledgements

Victor F. Mautner and Thorsten Derlin contributed equally.

Parts of the cohort of patients in this retrospective study have been used for the evaluation of the relevance of intra-tumoural heterogeneity: Salamon J, Derlin T, Bannas P et al (2013) Evaluation of intra-tumoural heterogeneity on (18)F-FDG PET/CT for characterization of peripheral nerve sheath tumours in neurofibromatosis type 1. Eur J Nucl Med Mol Imaging 40:685-692.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

    Johannes Salamon, Simon Veldhoen, Peter Bannas, Jin Yamamura, Jochen Herrmann, Gerhard Adam & Thorsten Derlin

  2. Department of Diagnostic and Interventional Radiology, University Medical Centre Würzburg, Würzburg, Germany

    Simon Veldhoen

  3. Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany

    Ivayla Apostolova

  4. Department of Oral and Maxillofacial Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

    Reinhard E. Friedrich

  5. Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

    Victor F. Mautner

  6. Department of Diagnostic and Interventional Radiology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Johannes Salamon

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  1. Johannes Salamon
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Correspondence to Johannes Salamon.

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Salamon, J., Veldhoen, S., Apostolova, I. et al. 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. Eur Radiol 24, 405–412 (2014). https://doi.org/10.1007/s00330-013-3020-x

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  • DOI: https://doi.org/10.1007/s00330-013-3020-x

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