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Anders R, Hirsch FW, Roth C. [Neurofibromatosis type 1 : From diagnosis to follow-up]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:1050-1057. [PMID: 36070094 DOI: 10.1007/s00117-022-01059-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a tumor predisposition syndrome and is one of the most common genetic diseases. It is therefore a condition encountered by radiologists in clinical routine. Since the variability of the clinical expression is very high and several organ systems are affected, we present a standardized diagnostic approach in this article. METHODS Evaluation of the literature on neurofibromatosis type 1 in the context of radiological examination methods. RESULTS In addition to the frequently known changes in the central and peripheral nervous system such as optic gliomas and plexiform neurofibromas, lesions from the orthopedic spectrum and vascular changes must also be included in the radiological diagnosis. CONCLUSIONS Due to the diversity of the clinical picture of NF1, it is reasonable to define an examination strategy which takes into account the needs of radiological routine and also reliably detects the most frequent and prognostically significant pathologies accompanying this disease. In this article, the current recommendations for diagnosis of neurofibromatosis-associated tumors and skeletal changes are summarized, and examination protocols and time intervals are suggested.
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Affiliation(s)
- Rebecca Anders
- Institut für Kinderradiologie, Universitätsklinikum Leipzig, Liebigstr. 20a, 04103, Leipzig, Deutschland
| | - Franz Wolfgang Hirsch
- Institut für Kinderradiologie, Universitätsklinikum Leipzig, Liebigstr. 20a, 04103, Leipzig, Deutschland
| | - Christian Roth
- Institut für Kinderradiologie, Universitätsklinikum Leipzig, Liebigstr. 20a, 04103, Leipzig, Deutschland.
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2
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Martin E, Geitenbeek RTJ, Coert JH, Hanff DF, Graven LH, Grünhagen DJ, Verhoef C, Taal W. A Bayesian approach for diagnostic accuracy of malignant peripheral nerve sheath tumors: a systematic review and meta-analysis. Neuro Oncol 2021; 23:557-571. [PMID: 33326583 PMCID: PMC8041346 DOI: 10.1093/neuonc/noaa280] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Malignant peripheral nerve sheath tumors (MPNST) carry a dismal prognosis and require early detection and complete resection. However, MPNSTs are prone to sampling errors and biopsies or resections are cumbersome and possibly damaging in benign peripheral nerve sheath tumor (BPNST). This study aimed to systematically review and quantify the diagnostic accuracy of noninvasive tests for distinguishing MPNST from BPNST. Methods Studies on accuracy of MRI, FDG-PET (fluorodeoxyglucose positron emission tomography), and liquid biopsies were identified in PubMed and Embase from 2000 to 2019. Pooled accuracies were calculated using Bayesian bivariate meta-analyses. Individual level-patient data were analyzed for ideal maximum standardized uptake value (SUVmax) threshold on FDG-PET. Results Forty-three studies were selected for qualitative synthesis including data on 1875 patients and 2939 lesions. Thirty-five studies were included for meta-analyses. For MRI, the absence of target sign showed highest sensitivity (0.99, 95% CI: 0.94-1.00); ill-defined margins (0.94, 95% CI: 0.88-0.98); and perilesional edema (0.95, 95% CI: 0.83-1.00) showed highest specificity. For FDG-PET, SUVmax and tumor-to-liver ratio show similar accuracy; sensitivity 0.94, 95% CI: 0.91-0.97 and 0.93, 95% CI: 0.87-0.97, respectively, specificity 0.81, 95% CI: 0.76-0.87 and 0.79, 95% CI: 0.70-0.86, respectively. SUVmax ≥3.5 yielded the best accuracy with a sensitivity of 0.99 (95% CI: 0.93-1.00) and specificity of 0.75 (95% CI: 0.56-0.90). Conclusions Biopsies may be omitted in the presence of a target sign and the absence of ill-defined margins or perilesional edema. Because of diverse radiological characteristics of MPNST, biopsies may still commonly be required. In neurofibromatosis type 1, FDG-PET scans may further reduce biopsies. Ideal SUVmax threshold is ≥3.5.
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Affiliation(s)
- Enrico Martin
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ritchie T J Geitenbeek
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - J Henk Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - David F Hanff
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Laura H Graven
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Walter Taal
- Department of Neuro-Oncology/Neurology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
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Dewey BJ, Howe BM, Spinner RJ, Johnson GB, Nathan MA, Wenger DE, Broski SM. FDG PET/CT and MRI Features of Pathologically Proven Schwannomas. Clin Nucl Med 2021; 46:289-296. [PMID: 33443952 DOI: 10.1097/rlu.0000000000003485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The aim of this study was to examine the MRI and FDG PET/CT imaging features of pathologically proven schwannomas. PATIENTS AND METHODS This institutional review board-approved retrospective study examined biopsy-proven schwannomas that underwent FDG PET/CT and/or MRI at our institution between January 1, 2002, and April 1, 2018. PET/CT features analyzed included SUVmax, metabolic ratios, volumetric metabolic measures, presence of calcification, and pattern of FDG activity. MRI features included T1/T2 signal, enhancement pattern, margins, perilesional edema, presence of muscular denervation, and size. RESULTS Ninety-five biopsy-proven schwannomas were identified (40 with both PET and MRI, 35 with PET only, and 20 with MRI only), 46 females and 49 males, average age of 57.7 ± 15.3 years. The average largest dimension was 4.6 ± 2.7 cm, the average SUVmax was 5.4 ± 2.7, and lesion SUVmax/liver SUVmean was 2.2 ± 1.2. Eleven (15%) of 75 lesions had SUVmax greater than 8.1, 26/75 (35%) had SUVmax greater than 6.1, and 14/75 (19%) had lesion SUVmax/liver SUVmean greater than 3.0. On MRI, 29/53 (55%) demonstrated internal nonenhancing areas. Twenty-eight (70%) of 40 lesions with both MRI and PET demonstrated at least 1 imaging feature concerning for malignant peripheral nerve sheath tumor (irregular margins, internal nonenhancement, perilesional edema, heterogeneous FDG uptake, or SUVmax >8.1). Lesions with heterogeneous FDG activity had higher SUVmax (6.5 ± 0.5 vs 4.7 ± 0.4, P = 0.0031) and more frequent internal nonenhancement on MRI (P = 0.0218). CONCLUSIONS Schwannomas may be large, be intensely FDG avid, and demonstrate significant heterogeneity, features typically associated with malignant peripheral nerve sheath tumors. A significant proportion exhibit FDG activity above cutoff levels previously thought useful in differentiating malignant from benign peripheral nerve sheath tumors.
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Nishida Y, Ikuta K, Ito S, Urakawa H, Sakai T, Koike H, Ito K, Imagama S. Limitations and benefits of FDG-PET/CT in NF1 patients with nerve sheath tumors: A cross-sectional/longitudinal study. Cancer Sci 2021; 112:1114-1122. [PMID: 33415792 PMCID: PMC7935790 DOI: 10.1111/cas.14802] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 12/11/2022] Open
Abstract
The purposes of this study were to re-confirm the usefulness of PET/CT in the differentiation of benignity/malignancy of neurogenic tumors in NF1 patients, and to analyze the natural course of plexiform neurofibroma (pNF) and clarify whether PET/CT is also useful for detecting tumors other than neurogenic tumors. PET/CT was prospectively imaged in 36 NF1 patients. There were 14 malignant peripheral nerve sheath tumors (MPNSTs) in 14 patients, and 54 pNFs in 30 patients. Nine patients had both MPNST and pNF. Maximal standardized uptake value (SUVmax) was significantly higher in MPNST (median 7.6: range 4.1-10.4) (P < .001) compared with that of pNF (median 3.7: range 1.6-9.3). The cut-off value of 5.8 resulted in a sensitivity of 78.6% and specificity of 88.9%. Median age was 29 y, and median maximum tumor diameter was 82 mm in 14 MPNST patients. The 5-y overall survival rate was 46.8%. Three patients with low-grade MPNST were alive without disease at the time of this report. In 9 patients in which pNF and MPNST co-existed, 2 showed a higher SUVmax of pNF than that of MPNST. Natural history analysis of pNF (n = 43) revealed that no factors significantly correlated with increased tumor size. Nine lesions other than neurogenic tumors were detected by PET/CT including 5 thyroid lesions and 3 malignant neoplasms. This study revealed the usefulness and limitation of PET/CT for NF1 patients. In the future, it will be necessary to study how to detect over time the malignant transformation of pNF to MPNST, via an intermediate tumor.
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Affiliation(s)
- Yoshihiro Nishida
- Department of Rehabilitation MedicineNagoya University HospitalNagoyaJapan
- Department of Orthopaedic SurgeryNagoya University HospitalNagoyaJapan
| | - Kunihiro Ikuta
- Department of Orthopaedic SurgeryNagoya University HospitalNagoyaJapan
- Medical Genetics CenterNagoya University HospitalNagoyaJapan
| | - Shinji Ito
- Department of RadiologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Hiroshi Urakawa
- Department of Orthopaedic SurgeryNagoya University HospitalNagoyaJapan
| | - Tomohisa Sakai
- Department of Orthopaedic SurgeryNagoya University HospitalNagoyaJapan
| | - Hiroshi Koike
- Department of Orthopaedic SurgeryNagoya University HospitalNagoyaJapan
| | - Kan Ito
- Department of Orthopaedic SurgeryNagoya University HospitalNagoyaJapan
| | - Shiro Imagama
- Department of Orthopaedic SurgeryNagoya University HospitalNagoyaJapan
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Smitherman AB, Gold SH, Davis IJ. FDG PET in the Diagnosis and Management of Pediatric and Adolescent Sarcomas. PET/CT AND PET/MR IN MELANOMA AND SARCOMA 2021:179-199. [DOI: 10.1007/978-3-030-60429-5_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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6
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Current status and recommendations for imaging in neurofibromatosis type 1, neurofibromatosis type 2, and schwannomatosis. Skeletal Radiol 2020; 49:199-219. [PMID: 31396668 DOI: 10.1007/s00256-019-03290-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 02/02/2023]
Abstract
Neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), and schwannomatosis (SWN) are three clinically distinct tumor predisposition syndromes with a shared tendency to develop peripheral and central nervous system neoplasms. Disease expression and complications of NF1, NF2, and SWN are highly variable, necessitating a multidisciplinary approach to care in order to optimize outcomes. This review will discuss the imaging appearance of NF1, NF2, and SWN and highlight the important role that imaging plays in informing management decisions in people with tumors associated with these syndromes. Recent technological advances, including the role of both whole-body and localized imaging strategies, routine anatomic and advanced magnetic resonance (MR) imaging sequences such as diffusion-weighted imaging (DWI) with quantitative apparent diffusion coefficient (ADC) mapping, and metabolic imaging techniques (MR spectroscopy and positron emission testing) are discussed in the context of the diagnosis and management of people with NF1, NF2, and SWN based on the most up-to-date clinical imaging studies.
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Ahlawat S, Blakeley JO, Rodriguez FJ, Fayad LM. Imaging biomarkers for malignant peripheral nerve sheath tumors in neurofibromatosis type 1. Neurology 2019; 93:e1076-e1084. [PMID: 31395668 DOI: 10.1212/wnl.0000000000008092] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To determine the utility of quantitative metrics obtained from fMRI using diffusion-weighted imaging (DWI)/apparent diffusion coefficient (ADC) mapping compared with metabolic (18F-fluorodeoxyglucose [FDG]-PET/CT) imaging in patients with neurofibromatosis type 1 (NF1) for the characterization of peripheral nerve sheath tumors (PNSTs) as benign or malignant. METHODS This Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant study retrospectively reviewed imaging of 55 PNSTs in 21 patients with NF1. Imaging included anatomic (unenhanced T1, fluid-sensitive, contrast-enhanced T1-weighted), functional DWI (b = 50, 400, 800 s/mm2) and ADC mapping, magnetic resonance sequences, and FDG-PET/CT imaging. Anatomic (size), functional (minimum ADC values), and metabolic (maximum standardized uptake values [SUVmax]) imaging characteristics were recorded. ADC values were correlated with SUVmax. With histologic correlation for all malignant PNSTs (MPNSTs) or clinical or imaging stability (>12 months) for benign lesions used as reference standards, diagnostic accuracy was calculated. RESULTS Of 55 PNSTs, there were 19 (35%) malignant and 36 (65%) benign PNSTs. Benign PNSTs were overall smaller than MPNSTs (largest diameter 4.3 ± 1.3 vs 8.2 ± 3.3 cm, respectively, p = 0.014). Benign PNSTs had higher ADCmin (×10-3 mm2/s) than MPNSTs (1.6 ± 0.4 vs 0.6 ± 0.2, respectively, p < 0.0001) and lower SUVmax than MPNSTs (3.2 ± 1.8 vs 8 ± 3.9, p < 0.0001, respectively). ADCmin correlated inversely with SUVmax (correlation coefficient r = -0.0.58, p < 0.0001). Maintaining a sensitivity of 100% with threshold values of ADCmin ≤1 or SUVmax >3.2, DWI yielded a specificity of 94% while FDG-PET/CT offered a specificity of 83%. CONCLUSIONS Both quantitative metabolic imaging and functional imaging offer high sensitivity for the characterization of PNSTs in NF1; however, DWI/ADC mapping offers increased specificity and may be a more useful modality. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with NF1, MRI using DWI/ADC mapping accurately distinguishes malignant and benign PNSTs.
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Affiliation(s)
- Shivani Ahlawat
- From The Johns Hopkins University School of Medicine, Baltimore, MD.
| | | | | | - Laura M Fayad
- From The Johns Hopkins University School of Medicine, Baltimore, MD
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8
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How Effective Are Noninvasive Tests for Diagnosing Malignant Peripheral Nerve Sheath Tumors in Patients with Neurofibromatosis Type 1? Diagnosing MPNST in NF1 Patients. Sarcoma 2019; 2019:4627521. [PMID: 31354382 PMCID: PMC6636541 DOI: 10.1155/2019/4627521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/30/2019] [Indexed: 12/21/2022] Open
Abstract
Background Distinguishing between benign and malignant peripheral nerve sheath tumors (MPNSTs) in neurofibromatosis 1 (NF1) patients prior to excision can be challenging. How can MPNST be most accurately diagnosed using clinical symptoms, magnetic resonance imaging (MRI) findings (tumor size, depth, and necrosis), positron emission tomography (PET) measures (SUVpeak, SUVmax, SUVmax tumor/SUVmean liver, and qualitative scale), and combinations of the above? Methods. All NF1 patients who underwent PET imaging at our institution (January 1, 2007–December 31, 2016) were included. Medical records were reviewed for clinical findings; MR images and PET images were interpreted by two fellowship-trained musculoskeletal and nuclear medicine radiologists, respectively. Receiver operating characteristic (ROC) curves were created for each PET measurement; the area under the curve (AUC) and thresholds for diagnosing malignancy were calculated. Logistic regression determined significant predictors of malignancy. Results Our population of 41 patients contained 34 benign and 36 malignant tumors. Clinical findings did not reliably predict MPNST. Tumor depth below fascia was highly sensitive; larger tumors were more likely to be malignant but without a useful cutoff for diagnosis. Necrosis on MRI was highly accurate and was the only significant variable in the regression model. PET measures were highly accurate, with AUCs comparable and cutoff points consistent with prior studies. A diagnostic algorithm was created using MRI and PET findings. Conclusions MRI and PET were more effective at diagnosing MPNST than clinical features. We created an algorithm for preoperative evaluation of peripheral nerve sheath tumors in NF1 patients, for which additional validation will be indicated.
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Abstract
Soft tissue sarcomas (STSs) account for less than 1% of adult solid tumors and about 7% of pediatric malignancies, causing 2% of cancer-related deaths. With the advent of PET-computed tomography (CT), the value of (18) fluorine-2-fluoro-2-deoxy-d-glucose (FDG) PET imaging to improve the management of STSs has been explored. FDG PET imaging has been found useful in restaging and treatment response assessment. This article reviews current knowledge and application of FDG PET-CT in initial diagnosis, staging, restaging, treatment response monitoring, and prognosis, with a brief overview of the most common histologic subtypes of STS.
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Evaluation of the most commonly used (semi-)quantitative parameters of 18F-FDG PET/CT to detect malignant transformation of neurofibromas in neurofibromatosis type 1. Nucl Med Commun 2018; 39:961-968. [PMID: 30106798 DOI: 10.1097/mnm.0000000000000889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In patients with neurofibromatosis type 1, transformation of neurofibromas into a malignant peripheral nerve sheath tumor (MPNST) is a severe complication of the disease. Fluorine-18-fluorodeoxyglucose PET/computed tomography (PET/CT) is a viable option for detecting malignant tumors in neurofibromatosis type 1 patients. The aim of this review was to assess the diagnostic performance of the most frequently used parameters of PET/CT in detecting MPNST. An extensive computer search was performed using the Cochrane Library, Pubmed, and Medline/Embase databases. Two reviewers independently extracted data of relevant studies and assessed the methodological quality (QUADAS-2). The diagnostic performance of PET/CT parameters in individual studies was determined by calculating a diagnostic odds ratio (DOR) using the absolute numbers of true-positive, true-negative, false-positive, and false-negative test results. A total of eight studies were included, of which three evaluated the standardized uptake value as a diagnostic parameter, two assessed the tumor-to-liver (T/L) ratio, and three articles described both parameters. The cut-off values for maximum standardized uptake value (SUVmax) ranged from 3.2 to 4.5; for the T/L ratio, the cut-off values were between 1.0 and 4.3. The sensitivity and specificity ranged from 90 to 100% and from 80 to 100%, respectively (SUVmax). T/L ratios were associated with 92-100% sensitivity and 72-94% specificity. The corresponding DORs ranged from 57 to 145 (SUVmax) and 35 to 655 (T/L ratio). Both the SUV and the T/L ratio are associated with high sensitivity combined with acceptable specificity in detecting MPNST. There is a tendency toward higher DORs using the T/L ratio, but the number of studies is limited.
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Raad RA, Lala S, Allen JC, Babb J, Mitchell CW, Franceschi AM, Yohay K, Friedman KP. Comparison of hybrid 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging and positron emission tomography/computed tomography for evaluation of peripheral nerve sheath tumors in patients with neurofibromatosis type 1. World J Nucl Med 2018; 17:241-248. [PMID: 30505221 PMCID: PMC6216733 DOI: 10.4103/wjnm.wjnm_71_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Rapidly enlarging, painful plexiform neurofibromas (PN) in neurofibromatosis type 1 (NF1) patients are at higher risk for harboring a malignant peripheral nerve sheath tumor (MPNST). Fludeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) has been used to support more invasive diagnostic and therapeutic interventions. However, PET/CT imparts an untoward radiation hazard to this population with tumor suppressor gene impairment. The use of FDG PET coupled with magnetic resonance imaging (MRI) rather than CT is a safer alternative but its relative diagnostic sensitivity requires verification. Ten patients (6 females, 4 males, mean age 27 years, range 8–54) with NF1 and progressive PN were accrued from our institutional NF Clinic. Indications for PET scanning included increasing pain and/or progressive disability associated with an enlarging PN on serial MRIs. Following a clinically indicated whole-body FDG PET/CT, a contemporaneous PET/MRI was obtained using residual FDG activity with an average time interval of 3–4 h FDG-avid lesions were assessed for both maximum standardized uptake value (SUVmax) from PET/CT and SUVmax from PET/MR and correlation was made between the two parameters. 26 FDG avid lesions were detected on both PET/CT and PET/MR with an accuracy of 100%. SUVmax values ranged from 1.4–10.8 for PET/CT and from 0.2-5.9 for PET/MRI. SUVmax values from both modalities demonstrated positive correlation (r = 0.45, P < 0.001). PET/MRI radiation dose was significantly lower (53.35% ± 14.37% [P = 0.006]). In conclusion, PET/MRI is a feasible alternative to PET/CT in patients with NF1 when screening for the potential occurrence of MPNST. Reduction in radiation exposure approaches 50% compared to PET/CT.
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Affiliation(s)
- Roy A Raad
- Department of Radiology, NYU School of Medicine, New York, NY 10016, USA
| | - Shailee Lala
- Department of Radiology, NYU School of Medicine, New York, NY 10016, USA
| | - Jeffrey C Allen
- Department of Pediatrics and Neurology, NYU School of Medicine, New York, NY 10016, USA
| | - James Babb
- Department of Radiology, NYU School of Medicine, New York, NY 10016, USA
| | | | - Ana M Franceschi
- Department of Radiology, NYU School of Medicine, New York, NY 10016, USA
| | - Kaleb Yohay
- Department of Radiology, NYU School of Medicine, New York, NY 10016, USA
| | - Kent P Friedman
- Department of Radiology, NYU School of Medicine, New York, NY 10016, USA
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Azizi AA, Slavc I, Theisen BE, Rausch I, Weber M, Happak W, Aszmann O, Hojreh A, Peyrl A, Amann G, Benkoe TM, Wadsak W, Kasprian G, Staudenherz A, Hacker M, Traub-Weidinger T. Monitoring of plexiform neurofibroma in children and adolescents with neurofibromatosis type 1 by [ 18 F]FDG-PET imaging. Is it of value in asymptomatic patients? Pediatr Blood Cancer 2018; 65. [PMID: 28771999 DOI: 10.1002/pbc.26733] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/20/2017] [Accepted: 07/02/2017] [Indexed: 12/27/2022]
Abstract
PURPOSE About 10% of patients with neurofibromatosis type 1 (NF-1) develop malignant peripheral nerve sheath tumours (MPNST) mostly arising in plexiform neurofibroma (PN); 15% of MPNST arise in children and adolescents. 2-[18 F]fluoro-2-deoxy-d-glucose ([18 F]FDG)-PET (where PET is positron emission tomography) is a sensitive method in differentiating PN and MPNST in symptomatic patients with NF-1. This study assesses the value of [18 F]FDG-PET imaging in detecting malignant transformation in symptomatic and asymptomatic children with PN. METHODS Forty-one patients with NF-1 and extensive PN underwent prospective [18 F]FDG imaging from 2003 to 2014. Thirty-two of the patients were asymptomatic. PET data, together with histological results and clinical course were re-evaluated retrospectively. Maximum standardised uptake values (SUVmax) and lesion-to-liver ratio were assessed. RESULTS A total of 104 examinations were performed. Mean age at first PET was 13.5 years (2.6-22.6). Eight patients had at least one malignant lesion; four of these patients were asymptomatic. Two of four symptomatic patients died, while all patients with asymptomatic malignant lesions are alive. All malignant tumours could be identified by PET imaging in both symptomatic and asymptomatic patients. All lesions judged as benign by [18 F]FDG imaging and clinical judgment were either histologically benign if removed or remained clinically silent during follow-up. SUVmax of malignant and benign lesions overlapped, but no malignant lesion showed FDG uptake ≤3.15. Asymptomatic malignant lesions were detected with a sensitivity of 100%, a negative predictive value of 100% and a specificity of 45.1%. CONCLUSION Malignant transformation of PN also occurs in asymptomatic children and adolescents. Detection of MPNST at early stages could increase the possibility of oncologically curative resections.
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Affiliation(s)
- Amedeo A Azizi
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Benjamin Emile Theisen
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ivo Rausch
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Happak
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Oskar Aszmann
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Azadeh Hojreh
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Peyrl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Gabriele Amann
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - Thomas M Benkoe
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Wadsak
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Anton Staudenherz
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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Ishibashi M, Tanabe Y, Fujii S, Ogawa T. Pictorial review of 18F-FDG PET/CT findings in musculoskeletal lesions. Ann Nucl Med 2017; 31:437-453. [PMID: 28585058 DOI: 10.1007/s12149-017-1182-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/27/2017] [Indexed: 11/26/2022]
Abstract
We herein reviewed 18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) findings in a number of musculoskeletal lesions including malignant tumors, benign tumors, and tumor-like lesions with correlations to other radiographic imaging modalities, and described the diversity of the 18F-FDG PET/CT findings of this entity. Malignant primary musculoskeletal tumors are typically 18F-FDG avid, whereas low-grade malignant tumors show mild uptake. Benign musculoskeletal tumors generally show a faint uptake of 18F-FDG, and tumor-like conditions also display various uptake patterns of 18F-FDG. Although musculoskeletal tumors show various uptakes of 18F-FDG on PET/CT, its addition to morphological imaging modalities such as CT and MRI is useful for the characterization and differentiation of musculoskeletal lesions.
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Affiliation(s)
- Mana Ishibashi
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan.
| | - Yoshio Tanabe
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Toshihide Ogawa
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
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The Role of [ 18F]FDG-PET/CT in Predicting Malignant Transformation of Plexiform Neurofibromas in Neurofibromatosis-1. Int J Surg Oncol 2016; 2016:6162182. [PMID: 28058117 PMCID: PMC5183794 DOI: 10.1155/2016/6162182] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 01/30/2023] Open
Abstract
Background. Malignant peripheral nerve sheath tumours (MPNSTs) are difficult to diagnose and treat and contribute to significant morbidity and mortality for patients with Neurofibromatosis-1 (NF-1). FDG-PET/CT is being increasingly used as an imaging modality to discriminate between benign and malignant plexiform neurofibromas. Objectives. To assess the value of FDG-PET/CT in differentiating between benign and malignant peripheral nerve lesions for patients with Neurofibromatosis-1. Methods. A systematic review of the literature was performed prior to application of stringent selection criteria. Ultimately 13 articles with 796 tumours were deemed eligible for inclusion into the review. Results. There was a significant difference between mean SUVmax of benign and malignant lesions (1.93 versus 7.48, resp.). Sensitivity ranged from 89 to 100% and specificity from 72 to 94%. ROC analysis was performed to maximise sensitivity and specificity of SUVmax cut-off; however no clear value was identified (range 3.1–6.1). Significant overlap was found between the SUVmax of benign and malignant lesions making differentiation of lesions difficult. Many of the studies suffered from having a small cohort and from not providing histological data on all lesions which underwent FDG-PET/CT. Conclusion. This systematic review is able to demonstrate that FDG-PET/CT is a useful noninvasive test for discriminating between benign and malignant lesions but has limitations and requires further prospective trials.
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Evaluation of (18)F-FDG PET and MRI in differentiating benign and malignant peripheral nerve sheath tumors. Skeletal Radiol 2016; 45:1097-105. [PMID: 27115884 DOI: 10.1007/s00256-016-2394-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 03/20/2016] [Accepted: 04/11/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare 18F-FDG PET/CT and MRI for differentiating benign and malignant peripheral nerve sheath tumors (BPNSTs and MPNSTs) and correlate imaging characteristics with histopathology. MATERIALS AND METHODS Patients with pathologically proven PNSTs undergoing 18F-FDG PET/CT were retrospectively reviewed. PET/CTs and, if available, MRIs were analyzed, noting multiple imaging characteristics and likely pathology (benign or malignant). RESULTS Thirty-eight patients with 23 BPNSTs and 20 MPNSTs were analyzed. MPNSTs had higher SUVmax (10.1 ± 1.0, 4.2 ± 0.4, p < 0.0001), metabolic tumor volume (146.5 ± 39.4, 21.7 ± 6.6 cm(3), p = 0.01), total lesion glycolysis (640.7 ± 177.5, 89.9 ± 23.2 cm(3)*g/ml, p = 0.01), and SUVmax/LiverSUVmean (5.3 ± 0.5, 2.0 ± 0.2, p < 0.0001). All lesions with SUVmax < 4.3 were benign. All lesions with SUVmax > 8.1 were malignant. SUVmax cutoff of 6.1 yielded 90.0 % sensitivity and 78.3 % specificity for MPNSTs. SUVmax/LiverSUVmean cutoff of 3.0 yielded 90.0 % sensitivity and 82.6 % specificity. MPNSTs more commonly had heterogeneous FDG activity (p < 0.0001), perilesional edema (p = 0.004), cystic degeneration/necrosis (p = 0.015), and irregular margins (p = 0.004). There was no difference in lesion size, MRI signal characteristics, or enhancement. Expertly interpreted MRI had 62.5-81.3 % sensitivity and 94.1-100.0 % specificity while PET had 90.0-100.0 % sensitivity and 52.2-82.6 % specificity for diagnosing MPNSTs. CONCLUSIONS FDG PET and MRI play a complementary role in PNST evaluation. Multiple metabolic parameters and MRI imaging characteristics are useful in differentiating BPNSTs from MPNSTs. This underscores the potential critical role of PET/MRI in these patients.
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Puranik AD, Purandare NC, Bal MM, Agrawal A, Shah S, Rangarajan V. FDG PET/CT detects benign neurofibromas presenting as nodal masses: Imaging hallmarks of a diagnostic "red herring". Indian J Nucl Med 2015; 30:148-50. [PMID: 25829735 PMCID: PMC4379676 DOI: 10.4103/0972-3919.152979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Multi-modality positron emission tomography/computed tomography (PET/CT) with 18F-fluoro-deoxy-glucose (FDG) depicts the enhancement pattern and metabolic intensity of lesions. Benign lesions with multiplicity, like neurofibromas often mimic similar appearing malignant neoplasms. We, report, a similar case where FDG PET/CT shows imaging hallmarks for diagnosing benign neurofibromas, in a patient with clinical presentation of lymphoma.
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Affiliation(s)
- Ameya D Puranik
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nilendu C Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Munita M Bal
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Chirindel A, Chaudhry M, Blakeley JO, Wahl R. 18F-FDG PET/CT qualitative and quantitative evaluation in neurofibromatosis type 1 patients for detection of malignant transformation: comparison of early to delayed imaging with and without liver activity normalization. J Nucl Med 2015; 56:379-85. [PMID: 25655626 DOI: 10.2967/jnumed.114.142372] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED (18)F-FDG PET/CT has shown increased accuracy, compared with morphologic imaging, in differentiating malignant peripheral nerve sheath tumors (MPNSTs) from benign neurofibromas (BNFs) in patients with neurofibromatosis type 1 (NF1). Delayed (18)F-FDG PET imaging typically enhances malignant tumor to background. Our goal was to compare the effectiveness of early (1-h) and delayed (4-h) (18)F-FDG PET/CT imaging in differentiating MPNSTs from BNFs in patients with NF1, with and without liver activity normalization. METHODS NF1 patients presenting new symptoms or enlarging lesions were clinically evaluated with early and delayed (18)F-FDG PET/CT imaging. SULmax (maximum standardized uptake value derived for lean body) and SULmax/liver (lesion uptake adjusted to mean liver activity) were obtained for all sites identified with abnormal metabolic activity. Qualitative and quantitative evaluations, including receiver-operating-characteristic (ROC) comparison of early and delayed imaging sessions, were performed. Histopathology and clinical follow-up (1-9 y) were considered as a gold standard. RESULTS Forty-one NF1 patients with early and delayed (18)F-FDG PET/CT scans were identified, and 93 lesions were retrospectively analyzed, representing 24 MPNSTs (all histologically confirmed) and 69 BNFs (26 histologically confirmed). Qualitative evaluation on early imaging showed sensitivity, specificity, positive predictive value, and negative predictive value for separating MPNSTs from BNFs of 91%, 84%, 67%, and 96% versus 91%, 81%, 63%, and 96%, respectively, on 4-h delayed imaging. The mean SULmax was significantly higher for MPNSTs than BNFs on both early scans (6.5 vs. 2.0, P < 0.01) and delayed imaging (8.3 vs. 2.3, P < 0.02). However, SULmax overlap between benign and malignant lesions persisted even after normalization to mean liver activity. ROC-derived best SULmax cutoffs were 3.2 on early (area under the curve, 0.973) and 4.1 on delayed scans (area under the curve, 0.978). ROC analysis for SULmax/liver improved test specificity (94% vs. 87%, P < 0.05) on early and (93% vs. 88%, P < 0.05) on delayed imaging. CONCLUSION Qualitative interpretation of (18)F-FDG PET/CT discriminates MPNSTs from BNFs in NF1 patients with similar accuracy on both early and delayed imaging. Quantitative data showed better sensitivity on delayed acquisition and best test specificity with lesion SULmax normalization to liver activity, more so than with delayed imaging at 4 h.
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Affiliation(s)
- Alin Chirindel
- Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Radiation Oncology, University Medical Center, Frieburg, Germany, and German Cancer Research Center (DKFZ), Partner Site Freiburg, Freiburg, Germany
| | - Muhammad Chaudhry
- Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Jaishri O Blakeley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Richard Wahl
- Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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Kawaguchi T, Kawai N, Watanabe T, Yasukawa M, Morita K, Ohbayashi C, Tojo T. Primary intrathoracic malignant neurogenic tumor: report of three cases and comparison with benign neurogenic tumors resected at our institution. Surg Case Rep 2015; 1:6. [PMID: 26943374 PMCID: PMC4747924 DOI: 10.1186/s40792-014-0013-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/25/2014] [Indexed: 11/24/2022] Open
Abstract
We present three patients with intrathoracic malignant neurogenic tumor. Two lesions showed no sign of invasion into adjacent structures, while the third lesion extended to the intraspinal canal with vertebral involvement. Although all three lesions were completely excised, each patient relapsed within 1 year of the initial treatment. One patient with local recurrence underwent radiation therapy, but the recurrent tumor continued to progress. Chemotherapy was subsequently performed. Two patients with distant metastases also received chemotherapy. Because there is no effective chemotherapeutic regimen for intrathoracic malignant neurogenic tumor, all three patients received high-dose chemotherapy followed by hematopoietic stem cell transplantation. Although the relapsed lesions temporarily regressed after treatment, all three patients showed disease recrudescence and ultimately died of their disease. A comparison of the intrathoracic malignant neurogenic tumors and the benign neurogenic tumors resected at our institution revealed no meaningful differences distinguishing malignant from benign neurogenic tumors prior to surgery.
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Affiliation(s)
- Takeshi Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Norikazu Kawai
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Takashi Watanabe
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Motoaki Yasukawa
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Kohei Morita
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Takashi Tojo
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
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Yorita K, Yonei A, Ayabe T, Nakada H, Nakashima K, Fukushima T, Kataoka H. Posterior mediastinal ganglioneuroma with peripheral replacement by white and brown adipocytes resulting in diagnostic fallacy from a false-positive 18F-2-fluoro-2-deoxyglucose-positron emission tomography finding: a case report. J Med Case Rep 2014; 8:345. [PMID: 25319096 PMCID: PMC4204430 DOI: 10.1186/1752-1947-8-345] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 08/28/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Ganglioneuroma is a rare tumor in the posterior mediastinum; fat-containing ganglioneuromas are rarely reported. The present case report documents a brown fat-containing, posterior mediastinal ganglioneuroma, which has not been reported previously. Radiological examination, in particular 18F-2-fluoro-2-deoxyglucose-positron emission tomography, suggested that the tumor had low-grade malignant potential. This led to uncertainty at preoperative diagnosis. Case presentation An asymptomatic 66-year-old Japanese woman with no significant past medical history was referred for the evaluation of a posterior mediastinal mass. Although its size had not changed in the past 5 years, a malignant lipomatous tumor could not be excluded due to the presence of intratumoral fat and increased 18F-2-fluoro-2-deoxyglucose uptake observed by positron emission tomography imaging. A computed tomography-guided core-needle biopsy revealed a mixture of mature adipocytes, spindle-shaped cells, and fibrotic stroma. Definite diagnosis was not possible, and surgical resection was performed. Three years after the surgery, she remains disease-free. Conclusions Histological diagnosis of the surgically resected mass confirmed ganglioneuroma with substantial amounts of white and brown adipose tissues in peripheral areas. The existence of both ganglion cells and brown fat tissue intensified the accumulation of 18F-2-fluoro-2-deoxyglucose, resulting in a false-positive result by positron emission tomography. Considering this, ganglioneuroma should not be excluded either clinically or pathologically in fat-containing, posterior mediastinal tumors.
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Affiliation(s)
- Kenji Yorita
- Section of Oncopathology and Regenerative Biology, Department of Pathology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan.
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Agarwal K, Sharma P, Kc S, Bal C, Kumar R. Giant thoracic ganglioneuroma in a pediatric patient: Staging and restaging with 18F-FDG PET-CT. Rev Esp Med Nucl Imagen Mol 2014. [DOI: 10.1016/j.remnie.2014.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Agarwal K, Sharma P, Kc S, Bal C, Kumar R. Giant thoracic ganglioneuroma in a pediatric patient: Staging and restaging with 18F-FDG PET-CT. Rev Esp Med Nucl Imagen Mol 2014; 33:310-1. [DOI: 10.1016/j.remn.2013.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 09/28/2013] [Accepted: 10/01/2013] [Indexed: 10/25/2022]
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de Blank P, Cole K, Kersun L, Green A, Wilkes JJ, Belasco J, Bagatell R, Bailey LC, Fisher MJ. fdg-pet in two cases of neurofibromatosis type 1 and atypical malignancies. ACTA ACUST UNITED AC 2014; 21:e345-8. [PMID: 24764718 DOI: 10.3747/co.21.1803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with neurofibromatosis type 1 (nf1) are at increased risk for both benign and malignant tumours, and distinguishing the malignant potential of an individual tumour is a common clinical problem in these patients. Here, we review two cases of uncommon malignancies (Hodgkin lymphoma and mediastinal germ-cell tumour) in patients with nf1. Although (18)F-fluorodeoxyglucose positron-emission tomography (fdg-pet) has been used to differentiate benign neurofibromas from malignant peripheral nerve sheath tumours, fdg-pet characteristics for more rare tumours have been poorly described in children with nf1. Here, we report the role of pet imaging in clinical decision-making in each case. In nf1, fdg-pet might be useful in the clinical management of unusual tumour presentations and might help to provide information about the malignant potential of uncommon tumours.
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Affiliation(s)
- P de Blank
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Rainbow Babies and Children's Hospital, Cleveland, OH, U.S.A
| | - K Cole
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A. ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - L Kersun
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A. ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - A Green
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A. ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - J J Wilkes
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A. ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - J Belasco
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A. ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - R Bagatell
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A. ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - L C Bailey
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A. ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - M J Fisher
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A. ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
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Utility of 18F-FDG PET with a semi-quantitative index in the detection of sarcomatous transformation in patients with neurofibromatosis type 1. PLoS One 2014; 9:e85954. [PMID: 24516522 PMCID: PMC3916322 DOI: 10.1371/journal.pone.0085954] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 12/04/2013] [Indexed: 01/30/2023] Open
Abstract
Background Malignant peripheral nerve sheath tumors (MPNSTs) are a serious complications of neurofibromatosis type 1 associated with poor prognosis and deeper lesions can be difficult to diagnose. 18-FDG PET improves the detection of malignancies. However, the criteria for malignancy, notably the SUVmax threshold, are not standardized. Therefore, the aim of the study was to evaluate a semi-quantitative index for the reproducible detection of MPNST with FDG PET. Methods It is a multicenter retrospective study conducted between 2000 to 2012. All patients with NF1 referred for suspected MPNST underwent PET. Since SUVmax was not available until 2004 in our centers, we had to settle for the semi-quantitative method used at that time, the uptake ratio between the tumor and the normal liver (T/L ratio) with 1.5 as the cut-off for malignancy. When dedicated PET with SUVmax became available, the semi-quantitative analysis of PET images remained, along with SUVmax. Results 113 patients with 145 tumors were included. PET assessment revealed 65 suspected lesions with T/L >1.5 and among these, 40 were MPNSTs. 80 tumors were classified as non-suspicious, and 79 were benign. The 1.5 T/L cut-off had a negative predictive value (NPV) of 98,8% and a positive predictive value of 61,5%. The positive likelihood ratio (LR) was 4,059, the negative LR was 0,032 with 97% sensitivity and 76% specificity. Conclusions This study, which is among the largest published, confirms the utility of PET for detecting NF1-associated MPNSTs. A semi-quantitative index, the T/L ratio with a cut-off of 1.5, allowed sensitive and specific differentiation of malignant from benign tumors better than SUVmax. When T/L was <1.5, MPNSTs were ruled out with 98,8% NPV. When T/L was >1.5, there was a strong suspicion of malignancy. This semi-quantitative analytical method is as simple as SUVmax, but is more sensitive, more reproducible and non-user-dependent.
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An unusual case of a malignant peripheral nerve sheath tumor. Arch Plast Surg 2013; 40:285-7. [PMID: 23730615 PMCID: PMC3665883 DOI: 10.5999/aps.2013.40.3.285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 03/28/2013] [Accepted: 03/29/2013] [Indexed: 11/26/2022] Open
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Salamon J, Derlin T, Bannas P, Busch JD, Herrmann J, Bockhorn M, Hagel C, Friedrich RE, Adam G, Mautner VF. Evaluation of intratumoural heterogeneity on ¹⁸F-FDG PET/CT for characterization of peripheral nerve sheath tumours in neurofibromatosis type 1. Eur J Nucl Med Mol Imaging 2012; 40:685-92. [PMID: 23232507 DOI: 10.1007/s00259-012-2314-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 11/23/2012] [Indexed: 12/18/2022]
Abstract
PURPOSE 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). METHODS 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. RESULTS 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. CONCLUSION 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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Affiliation(s)
- Johannes Salamon
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
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Usefulness of whole-body fluorine-18-fluorodeoxyglucose positron emission tomography in patients with neurofibromatosis type 1: a systematic review. Radiol Res Pract 2012; 2012:431029. [PMID: 22991664 PMCID: PMC3443985 DOI: 10.1155/2012/431029] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 07/13/2012] [Accepted: 08/04/2012] [Indexed: 12/19/2022] Open
Abstract
Aim. To systematically review the role of positron emission tomography (PET) with fluorine-18-fluorodeoxyglucose (FDG) in patients with neurofibromatosis type 1 (NF1). Methods. A comprehensive literature search of published studies regarding FDG-PET and PET/CT in patients with NF1 was performed. No beginning date limit and language restriction were used; the search was updated until December 2011. Only those studies or subsets in studies including whole-body FDG-PET or PET/CT scans performed in patients with NF1 were included. Results. We identified 12 studies including 352 NF1 patients. Qualitative evaluation was performed in about half of the studies and semiquantitative analysis, mainly based on different values of SUV cutoff, in the others. Most of the studies evaluated the role of FDG-PET for differentiating benign from malignant peripheral nerve sheath tumors (MPNSTs). Malignant lesions were detected with a sensitivity ranging between 100% and 89%, but with lower specificity, ranging between 100% and 72%. Moreover, FDG-PET seems to be an important imaging modality for predicting the progression to MPNST and the outcome in patients with MPNST. Two studies evaluated the role of FDG-PET in pediatric patients with NF1. Conclusions. FDG-PET and PET/CT are useful methods to identify malignant change in neurogenic tumors in NF1 and to discriminate malignant from benign neurogenic lesions.
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Abstract
OBJECTIVE We will describe and illustrate various musculoskeletal manifestations of neurofibromatosis type 1 (NF1) encountered on imaging studies. CONCLUSION Because NF1 is one of the most common genetic disorders, radiologists should be familiar with its imaging manifestations.
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Tsai LL, Drubach L, Fahey F, Irons M, Voss S, Ullrich NJ. [18F]-Fluorodeoxyglucose positron emission tomography in children with neurofibromatosis type 1 and plexiform neurofibromas: correlation with malignant transformation. J Neurooncol 2012; 108:469-75. [PMID: 22407214 DOI: 10.1007/s11060-012-0840-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 02/20/2012] [Indexed: 12/15/2022]
Abstract
The objective of this study was to investigate the predictive value of [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) in detecting malignant transformation of plexiform neurofibromas in children with neurofibromatosis type 1 (NF1). An electronic search of the medical records was performed to determine patients with NF1 who had undergone FDG-PET for plexiform neurofibroma between 2000 and 2011. All clinical, radiologic, pathology information and operative reports were reviewed. Relationship between histologic diagnosis, radiologic features and FDG-PET maximum standardized uptake value (SUV(max)) was evaluated. This study was approved by the Institutional Review Board of our institution. 1,450 individual patients were evaluated in our Multidisciplinary Neurofibromatosis Program, of whom 35 patients underwent FDG-PET for suspected MPNST based on change or progression of clinical symptoms, or MRI findings suggesting increased tumor size. Twenty patients had concurrent pathologic specimens from biopsy/excision of 27 distinct lesions (mean age 14.9 years). Pathologic interpretation of these specimens revealed plexiform and atypical plexiform neurofibromas (n = 8 each), low grade MPNST (n = 2), intermediate grade MPNST (n = 4), high grade MPNST (n = 2), GIST (n = 1) and non-ossifying fibroma (n = 1). SUV(max) of plexiform neurofibromas (including typical and atypical) was significantly different from MPNST (2.49 (SD = 1.50) vs. 7.63 (SD = 2.96), p < 0.001). A cutoff SUV(max) value of 4.0 had high sensitivity and specificity of 1.0 and 0.94 to distinguish between PN and MPNST. FDG-PET can be helpful in predicting malignant transformation in children with plexiform neurofibromas and determining the need for biopsy and/or surgical resection.
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Affiliation(s)
- L L Tsai
- Department of Radiology, Children's Hospital Boston, Boston, MA 02115, USA
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Affiliation(s)
- Julius July
- Toronto Western Hospital, University of Toronto, Toronto, Canada
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Walker EA, Salesky JS, Fenton ME, Murphey MD. Magnetic resonance imaging of malignant soft tissue neoplasms in the adult. Radiol Clin North Am 2011; 49:1219-34, vi. [PMID: 22024296 DOI: 10.1016/j.rcl.2011.07.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This review addresses the spectrum of malignant soft tissue tumors frequently found in adults. Rather than presenting a complete review, the focus of this discussion is on common lesions or lesions in which the diagnosis may be suggested on the basis of imaging. Diagnoses covered include undifferentiated high-grade pleomorphic sarcoma, fibrosarcoma, dermatofibrosarcoma protuberans, liposarcoma, synovial sarcoma, malignant peripheral nerve sheath tumor, clear cell sarcoma, hemangioendothelioma, hemangiopericytoma, angiosarcoma, and leiomyosarcoma.
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Affiliation(s)
- Eric A Walker
- Department of Radiology, Milton S. Hershey Medical Center, 500 University Drive, P.O. Box 850, Hershey, PA 17033, USA.
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32
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Hickeson M, Abikhzer G. Review of Physiologic and Pathophysiologic Sources of Fluorodeoxyglucose Uptake in the Chest Wall on PET. PET Clin 2011; 6:339-64. [PMID: 27156728 DOI: 10.1016/j.cpet.2011.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The chest wall can be defined as the osseous and soft tissue structures that form the outer framework of the thorax and move during breathing. Topics discussed in this article include physiologic uptake of fluorodeoxyglucose, benign diseases of the chest wall, and malignant tumors of the chest wall.
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Affiliation(s)
- Marc Hickeson
- Division of Nuclear Medicine, McGill University Health Centre, Royal Victoria Hospital, 687 Pine Avenue West, M2.11, Montreal, Quebec H3A 1A1, Canada
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Lin PC, Lin SH, Chou SH, Chen YW, Chang TT, Wu JR, Jaw TS, Dai ZK, Chao MC. Ganglioneuroma of Posterior Mediastinum in a 6-year-old Girl: Imaging for Pediatric Intrathoracic Incidentaloma. Kaohsiung J Med Sci 2010; 26:496-501. [DOI: 10.1016/s1607-551x(10)70078-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 03/22/2010] [Indexed: 01/12/2023] Open
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Boe J, Chimpiri AR, Liu CZ. Solitary fibrous tumor originating in the pelvis: a case report. J Radiol Case Rep 2010; 4:21-8. [PMID: 22470743 DOI: 10.3941/jrcr.v4i7.430] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
A 52 year old male presented with changes in bowel movements, and a mass was detected on digital rectal exam. Both CT and MRI revealed a large pelvic and gluteal mass filling the pelvic cavity displacing the adjacent pelvic structures. After surgical removal, pathology revealed solitary fibrous tumor; a rare neoplasm uncommonly discovered in the thorax, and even less commonly in extrapleural locations. We discuss in this article imaging findings and histological features of extrapleural solitary fibrous tumor.
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Affiliation(s)
- Justin Boe
- Department of Radiological Sciences, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
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35
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Pleomorphic adenoma mimicking malignant tumor in the parapharyngeal space in a patient with gastric carcinoma. Nucl Med Mol Imaging 2010; 44:143-5. [PMID: 25013526 DOI: 10.1007/s13139-010-0024-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 01/28/2010] [Accepted: 02/01/2010] [Indexed: 10/19/2022] Open
Abstract
A 68-year-old man underwent total gastrectomy for stomach cancer. On the follow-up FDG PET/CT image 18 months later, intense focal (18)F-fluorodeoxyglucose (FDG) uptake was noted in the right parapharyngeal space. This lesion showed intermediate signal intensity on T1-weighted image and heterogeneous high signal intensity on T2-weighted image. The mass was heterogenously enhanced by gadolinium enhancement. This lesion was pathologically confirmed as pleomorphic adenoma by excision. This case highlights the fact that both benign and malignant lesions in the parotid gland may exhibit intense FDG activity and the need for pathologic confirmation of parotid gland lesions for accurate disease staging.
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Malignant transformation in an area with elevated F-18 FDG uptake within a low metabolic benign neurofibroma. Clin Nucl Med 2010; 35:271-2. [PMID: 20305421 DOI: 10.1097/rlu.0b013e3181d18ff1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Karabatsou K, Kiehl TR, Wilson DM, Hendler A, Guha A. Potential role of 18fluorodeoxyglucose-positron emission tomography/computed tomography in differentiating benign neurofibroma from malignant peripheral nerve sheath tumor associated with neurofibromatosis 1. Neurosurgery 2010; 65:A160-70. [PMID: 19927062 DOI: 10.1227/01.neu.0000337597.18599.d3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Benign plexiform neurofibromas (PNfib), especially those occurring in patients with neurofibromatosis type 1, are at a significant risk of progressing to a malignant peripheral nerve sheath tumor (MPNST). Early diagnosis, followed by radical surgery and adjuvant radiation to maintain local tumor control, is of critical importance to prevent metastasis and subsequent mortality from MPNSTs. However, early diagnosis is hampered by the sensitivity of current imaging modalities such as computed tomography (CT) or magnetic resonance imaging to reliably detect this malignant transformation, which can occur heterogeneously in a PNfib to a MPNST. 18Fluorodeoxyglucose (18FDG)-positron emission tomography (PET) is linked to metabolism and proliferation of tissues and has been widely used in oncology including PNSTs. 18FDG-PET/CT has the added advantage of fusing metabolic and anatomic imaging data sets. METHODS In this prospective study, 9 neurofibromatosis type 1-associated PNfibs suspected to have undergone transformation to an MPNST were preoperatively evaluated by 18FDG-PET/CT and magnetic resonance imaging. A detailed histological evaluation correlated the average and regional standard uptake value (SUV) from the 18FDG-PET/CT to grade of malignancy of the suspected MPNST. RESULTS Imaging from 18FDG-PET/CT and associated SUV of the suspected MPNSTs demonstrated either a homogeneous or a heterogeneous pattern. Stratification of the maximal SUV to low (<4.0), intermediate (4.0-7.0), or high (>7.0) correlated to the proliferative index (Ki-67) and grade of MPNST. A maximal SUV of more than 7.0 was closely correlated to a focus of malignant transformation. CONCLUSION This study, on a limited number of cases, demonstrates the potential use of 18FDG-PET/CT to augment management of PNfibs, especially in the context of neurofibromatosis type 1, which is characterized by multiple tumors. The addition of CT anatomic imaging to 18FGD-PET can facilitate targeting biopsies to metabolic hot spots, to further augment diagnostic sensitivity. Much larger numbers of MPNSTs, which can only be accrued in a collaborative manner among institutions, are required to further assess the specificity and sensitivity of 18FDG-PET/CT in the diagnosis of MPNSTs.
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Affiliation(s)
- Konstantina Karabatsou
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
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Benz MR, Czernin J, Dry SM, Tap WD, Allen-Auerbach MS, Elashoff D, Phelps ME, Weber WA, Eilber FC. Quantitative F18-fluorodeoxyglucose positron emission tomography accurately characterizes peripheral nerve sheath tumors as malignant or benign. Cancer 2010; 116:451-8. [PMID: 19924789 DOI: 10.1002/cncr.24755] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Correct pretreatment classification is critical for optimizing diagnosis and treatment of patients with peripheral nerve sheath tumors (PNSTs). The aim of this study was to evaluate whether F18-fluorodeoxyglucose positron emission tomography (FDG PET) can differentiate malignant (MPNST) from benign PNSTs. METHODS Thirty-four adult patients presenting with PNST who underwent a presurgical FDG PET/computed tomography (CT) scan between February 2005 and November 2008 were included in the study. Tumors were characterized histologically, by FDG maximum standardized uptake value (SUV(max) [g/mL]), and by CT size (tumor maximal diameter [cm]). The accuracy of FDG PET for differentiating MPNSTs from benign PNSTs (neurofibroma and schwannoma) was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS SUV(max) was measured in 34 patients with 40 tumors (MPNSTs: n = 17; neurofibromas: n = 9; schwannomas: n = 14). SUV(max) was significantly higher in MPNST compared with benign PNST (12.0 +/- 7.1 vs 3.4 +/- 1.8; P < .001). An SUV(max) cutoff point of > or =6.1 separated MPNSTs from BPSNTs with a sensitivity of 94% and a specificity of 91% (P < .001). By ROC curve analysis, SUV(max) reliably differentiated between benign and malignant PNSTs (area under the ROC curve of 0.97). Interestingly, the difference between MPNSTs and schwannomas was less prominent than that between MPNSTs and neurofibromas. CONCLUSIONS Quantitative FDG PET imaging distinguished between MPNSTs and neurofibromas with high accuracy. In contrast, MPNSTs and schwannomas were less reliably distinguished. Given the difficulties in clinically evaluating PNST and in distinguishing benign PNST from MPNST, FDG PET imaging should be used for diagnostic intervention planning and for optimizing treatment strategies.
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Affiliation(s)
- Matthias R Benz
- Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, California 90095-1782, USA
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YAMAGUCHI R, YOSHIDA T, NAKAZATO Y, YOSHIMOTO Y. Solitary Intraosseous Neurofibroma of the Frontal Bone -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:683-6. [DOI: 10.2176/nmc.50.683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rei YAMAGUCHI
- Department of Neurosurgery, Gunma University Graduate School of Medicine
| | - Takaaki YOSHIDA
- Department of Neurosurgery, Gunma University Graduate School of Medicine
| | - Yoichi NAKAZATO
- Department of Pathology, Gunma University Graduate School of Medicine
| | - Yuhei YOSHIMOTO
- Department of Neurosurgery, Gunma University Graduate School of Medicine
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40
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Malignant peripheral nerve sheath tumour (MPNST): the clinical implications of cellular signalling pathways. Expert Rev Mol Med 2009; 11:e30. [DOI: 10.1017/s1462399409001227] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Malignant peripheral nerve sheath tumour (MPNST) is a rare malignancy accounting for 3–10% of all soft tissue sarcomas. Most MPNSTs arise in association with peripheral nerves or deep neurofibromas and may originate from neural crest cells, although the specific cell of origin is uncertain. Approximately half of MPNSTs occur in the setting of neurofibromatosis type 1 (NF1), an autosomal dominant disorder with an incidence of approximately one in 3500 persons; the remainder of MPNSTs develop sporadically. In addition to a variety of clinical manifestations, approximately 8–13% of NF1 patients develop MPNSTs, which are the leading cause of NF1-related mortality. Surgical resection is the mainstay of MPNST clinical management. However, because of invasive growth, propensity to metastasise, and limited sensitivity to chemotherapy and radiation, MPNST has a guarded to poor prognosis. Five-year survival rates of only 20–50% indicate an urgent need for improved therapeutic approaches. Recent work in this field has identified several altered intracellular signal transduction cascades and deregulated tyrosine kinase receptors, posing the possibility of personalised, targeted therapeutics. However, expanded knowledge of MPNST molecular pathobiology will be needed to meaningfully apply such approaches for the benefit of afflicted patients.
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Abstract
PURPOSE OF REVIEW 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) is being used with increased frequency in the care of patients with sarcoma. In this review, the recent literature covering all aspects of PET imaging in the management of patients with soft tissue and bone sarcomas will be discussed. RECENT FINDINGS In a prospective multicenter study, PET imaging accurately detected primary tumors as well as lymph node and bone metastases in patients with sarcoma. Limitations in detecting lung metastasis can be overcome by using a hybrid PET/CT scanner. In patients with neurofibromatosis, 18F-FDG-PET demonstrated its application to detect and monitor for the malignant transformation of neurofibromas. Changes in tumor 18F-FDG uptake correlate significantly with histopathologic response and survival in patients with sarcoma. SUMMARY PET imaging is emerging as an important imaging modality in the management of patients with sarcoma. Its applications include tumor grading, staging, therapeutic monitoring, and prognostication in adult and pediatric populations.
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Azad A, Chong G, Tauro A, Aly A, Tebbutt NC. 18F-FDG-PET imaging of a benign neurofibroma masquerading as metastatic oesophageal carcinoma. Med Oncol 2009; 27:230-2. [PMID: 19296240 DOI: 10.1007/s12032-009-9196-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 03/03/2009] [Indexed: 10/21/2022]
Abstract
We present the case of a 65-year-old male with squamous cell carcinoma of the thoracic oesophagus on a background of neurofibromatosis type 1. On computed tomography, he was noted to have a large left-sided superior mediastinal mass. Initially, this mass was thought to be metastatic lymphadenopathy; however, it did not display fluorodeoxyglucose uptake on positron emission tomography. Subsequent biopsy confirmed the mass to be a neurofibroma and the patient commenced definitive chemo-radiation. Positron emission tomography had a major impact on management since the presumed lymph node disease was not included in the radiation field. In addition, positron emission tomography altered prognostic stratification since lymph node involvement is a poor prognostic factor in oesophageal cancer. We could only identify one other case in the English literature in which positron emission tomography was used to distinguish metastatic carcinoma from a neurofibroma, although there are a number of reports that describe the utility of positron emission tomography in differentiating benign neurofibromas from malignant connective tissue tumours.
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Affiliation(s)
- A Azad
- Ludwig Institute Oncology Unit, University of Melbourne, Austin Hospital, Austin Health, Melbourne, VIC, Australia.
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43
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Slam KD, Bohman SL, Sharma R, Chaudhuri PK. Surgical Considerations for the Familial Cancer Syndrome, Neurofibromatosis 1: A Comprehensive Review. Am Surg 2009. [DOI: 10.1177/000313480907500203] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neurofibromatosis 1 is one of the more common in heritable disorders that surgeons may encounter. A plethora of systemic associations, both benign and malignant, can affect these patients, and an acute awareness of these associations is essential for proper surgical care. A complete review of this disorder from the surgical perspective follows, highlighting the importance of this awareness. A brief review on the management and follow-up of surgical malignancies associated with this disorder is included.
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Affiliation(s)
| | | | - Rupa Sharma
- Medical School, University of Toledo, Toledo, Ohio
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Warbey VS, Ferner RE, Dunn JT, Calonje E, O'Doherty MJ. [18F]FDG PET/CT in the diagnosis of malignant peripheral nerve sheath tumours in neurofibromatosis type-1. Eur J Nucl Med Mol Imaging 2009; 36:751-7. [PMID: 19142634 DOI: 10.1007/s00259-008-1038-0] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 11/28/2008] [Indexed: 12/14/2022]
Abstract
PURPOSE The detection of malignant peripheral nerve sheath tumours (MPNSTs) in patients with neurofibromatosis 1 (NF1) remains a clinical challenge. The purpose of this study was to evaluate the use of [(18)F]2-fluoro-2-deoxy-D-glucose PET/CT (FDG PET/CT with early and delayed imaging) in patients with symptomatic neurofibromas, to revalidate current cut-off values for identification of malignant change within neurofibromas and to examine the relationship between SUV and tumour grade. METHODS Patients with symptomatic neurofibromas underwent FDG PET/CT imaging at 90 and 240 min. Semiquantitative analysis using maximum standardized uptake value (SUVmax) was performed and correlated with histology. RESULT In 69 patients, 85 lesions were identified for analysis, including 10 atypical neurofibromas and 21 MPNSTs. Sensitivity of FDG PET/CT in diagnosing NF1-associated MPNST was 0.97 (95% CI 0.81-0.99) and the specificity was 0.87 (CI 0.74-0.95). There was a significant difference in SUVmax between early and delayed imaging and in SUVmax between tumours identified as benign and malignant on PET/CT. There was also a significant difference in SUVmax between tumour grades. CONCLUSION FDG PET/CT is a highly sensitive and specific imaging modality for the diagnosis of MPNST in NF1 patients. We recommend performing early (90 min) and delayed imaging at 4 h for accurate lesion characterization and using a cut-off SUVmax of 3.5 on delayed imaging to achieve maximal sensitivity.
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Affiliation(s)
- Victoria S Warbey
- Clinical PET Centre, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK.
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45
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Parsons CM, Canter RJ, Khatri V. Surgical Management of Neurofibromatosis. Surg Oncol Clin N Am 2009; 18:175-96, x. [DOI: 10.1016/j.soc.2008.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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46
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Matsumine A, Kusuzaki K, Nakamura T, Nakazora S, Niimi R, Matsubara T, Uchida K, Murata T, Kudawara I, Ueda T, Naka N, Araki N, Maeda M, Uchida A. Differentiation between neurofibromas and malignant peripheral nerve sheath tumors in neurofibromatosis 1 evaluated by MRI. J Cancer Res Clin Oncol 2008; 135:891-900. [DOI: 10.1007/s00432-008-0523-y] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 11/19/2008] [Indexed: 11/30/2022]
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Kim KT, Park YS, Kwon JT, Kim YB. Primary paraspinal malignant peripheral nerve sheath tumor. J Korean Neurosurg Soc 2008; 44:91-4. [PMID: 19096700 DOI: 10.3340/jkns.2008.44.2.91] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 07/24/2008] [Indexed: 01/30/2023] Open
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) are very rare tumors. We experienced a case of MPNST in the cervical paraspinal space which was not associated with neurofibromatosis. The tumor located in left C6-7 foramen and compressed C7 root. The tumor was removed through the occipital triangle. We report a case of the primary cerivcal MPNST in a patient who did not have neurofibromatosis-1.
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Affiliation(s)
- Kyoung-Tae Kim
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea
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Cordero García JM, Tembl Ferrairó A. [Giant neurofibroma with sarcomatous changes: study with 99mTc HDP and 99mTc DTPA]. ACTA ACUST UNITED AC 2008; 27:281-2. [PMID: 18682157 DOI: 10.1157/13124640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- J M Cordero García
- Servicio de Medicina Nuclear, Hospital de la Ribera, Alzira, Valencia, España.
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