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      Evaluation of intratumoural heterogeneity on ¹⁸F-FDG PET/CT for characterization of peripheral nerve sheath tumours in neurofibromatosis type 1.

      European Journal of Nuclear Medicine and Molecular Imaging
      Adolescent, Adult, Aged, Biological Transport, Child, Child, Preschool, Female, Fluorodeoxyglucose F18, diagnostic use, metabolism, Humans, Male, Middle Aged, Multimodal Imaging, Nerve Sheath Neoplasms, pathology, radionuclide imaging, Neurofibromatosis 1, Positron-Emission Tomography, Reproducibility of Results, Retrospective Studies, Tomography, X-Ray Computed, Young Adult

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          Abstract

          The aim of the study was to evaluate the potential usefulness of intratumoural tracer uptake heterogeneity on (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT as compared to a cut-off maximum standardized uptake value (SUVmax) for characterization of peripheral nerve sheath tumours (PNSTs) in neurofibromatosis type 1 (NF1). Fifty patients suffering from NF1 were examined by (18)F-FDG PET/CT. Intralesional tracer uptake was analysed qualitatively and semi-quantitatively by measuring the mean and maximum SUV. Uptake heterogeneity was graded qualitatively using a three-point scale and semi-quantitatively by calculating an SUV-based heterogeneity index (HISUV). Cohen's κ was used to determine inter- and intra-rater agreement. Histopathological evaluation and clinical as well as radiological follow-up examinations served as the reference standards. A highly significant correlation between the degree of intratumoural uptake heterogeneity on (18)F-FDG PET and malignant transformation of PNSTs was observed (p < 0.0001). Semi-quantitative HISUV was significantly higher in malignant PNSTs (MPNSTs) than in benign tumours (p = 0.0002). Both intralesional heterogeneity and SUVmax could be used to identify malignant tumours with a sensitivity of 100 %. Cohen's κ was 0.86 for inter-rater agreement and 0.88 for intra-rater agreement on heterogeneity. MPNSTs in patients with NF1 demonstrate considerable intratumoural uptake heterogeneity on (18)F-FDG PET/CT. Assessment of tumour heterogeneity is highly reproducible. Both tumour heterogeneity and a cut-off SUVmax may be used to sensitively identify malignant PNSTs, but the specificity is higher for the latter. A combination of both methods leads to a non-significant improvement in diagnostic performance.

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